This document summarizes acute rheumatic fever, which is an autoimmune disease triggered by a streptococcal infection. It most commonly affects children ages 5-15. It can cause inflammation of the heart (carditis), joints (arthritis), skin (erythema marginatum), and brain (chorea). The pathogenesis involves molecular mimicry between antigens in streptococcus and human tissues. Treatment involves bed rest, antibiotics to treat strep, and aspirin or steroids for suppression. Prevention relies on prompt strep treatment and long-term antibiotic prophylaxis to prevent recurrence, especially for those with heart valve damage.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. INTRODUCTION
Rheumatic fever is an immunological disorder
initiated by group A beta hemolytic
streptococci.
Antibodies produced against selected
streptococcal cell wall proteins and sugars
react with the connective tissues of the body
as well as the heart and results into rheumatic
fever.
3. EPIDEMIOLOGY
Most common form of acquired heart disease in
all age groups.
Constitutes from 5%-50% of the cardiac patients
in indian hospital.
AGE AND SEX:
Commonly affects between 5 and 15 years of
age; 1st episode rare before 3 yrs and after 30
years.
Incidence of rheumatic fever following
streptococcal throat infection is 0.3%.
1-3% in presence of epidemics of streptococcal
pharyngitis.
4. Sexes nearly equally affected
Mitral valve disease and chorea more common in
girls whereas aortic valve involvement often seen
in boys.
PREDISPOSING FACTORS: poor
socioeconomic conditions, unhygenic living
conditions and overcrowding
5. ETIOLOGY
Evidence supports link between antecedent beta
hemolytic group A streptococci and acute rheumatic
fever and rheumatic heart disease. It is indicated by
no. Of observations:
1. History of preceding sore throat is available in 50%
cases; >85% shows elevated ASO titre.
2. Epidemics of streptococcal infection are followed
by higher incidence of rheumatic fever.
3. Seasonal variation of rheumatic fever and
streptococcal infection is identical.
4. In patients with established RHD, streptococcal
infection is followed by recurrence of acute
rheumatic fever.
5. Penicillin prophylaxis for streptococcal infection
6. Certain GAS serotypes – M TYPE 1,3,5,6,18,29
are more frequently isolated from patients with
acute RF.
7. PATHOGENESIS
CYTOTOXICITY THEORY:
GAS toxin is involved in the pathogenesis of ARF
and RHD. Number of enzymes that are cytotoxic
for mammalian cardiac cells, such as
STREPTOLYSIN O, has a direct cytotoxic effect
on mammalian cells in tissue culture. Drawback-
inability to explain latent period between GAS
pharyngitis and onset of acute RF.( usually 10-21
days).
IMMUNE MEDIATED PATHOGENESIS:
the antigenicity of several GAS cellular and
extracellular epitopes and their imunologic cross
reactivity with cardiac antigenic epitopes
supports to the hypothesis of molecular mimicry.
8. Common epitopes are shared between certain GAS
components- M protein, cell membrane , group A cell wall
carbohydrate, capsular hyaluronate and specific
mammalian tissues – heartvalve, sarcolemma, brain,
joint.
certain rheumatogenic M proteins ( M1, M5,M6 and M 19)
share epitopes with human myocardial proteins such as
tropomyosin and myosin.
Another proposed pathogenetic hypothesis is binding of
M protein N terminal domain to a region of collagen type
4 leads to an antibody response to the collagen, resulting
in ground substance inflammation especially cardiac
valves and myocardium.
9.
10. Clinical features:
Streptococcal pharyngitis with fever followed 10
days to a few weeks later by recurrence of fever
and the manifestations of acute rheumatic fever.
Guidelines for the clinical diagnosis of acute
rheumatic fever , suggested by T. Duckett jones
revised by american heart assosciation.
Guidelines consists of major, minor, and
essential criteria
Two major or one major and two minor criteria
required to diagnose the first episode of ARF.
For recurrences, three minor criteria required.
11. In the 2015, jones criteria revision, a major
change from previous version expands the
definition of the major criterion carditis to include
subclinical evidence (eg, in the absence of
murmur , echocardiographic evidence of mitral
regurgitation meeting specific criteria to
distinguish physiologic from pathologic MR)
12.
13.
14. Major criteria
1. Carditis:
-it is an early manifestation, echocardiography
indicates carditis in 90% patients
-Rheumatic carditis is designated as a
pancarditis involving the pericardium,
myocardium and endocardium.
-almost 80% of patients develop carditis within
the first two weeks of onset.
-pericarditis results in precordial pain. On
auscultation ,friction rub is present. Only small
effusions and doesnot result in tamonade or
constrictive pericarditis.
15. - Rheumatic carditis always has additional mitral
or mitral and aortic regurgitation murmurs.
- other features of carditis are cardiac
enlargement, soft first heart sound,
protodiastolic gallop, congestive heart failure
and carey coombs murmur.
- Endocarditis is represented by a pansystolic
murmur of Mitral regurgitation with or without an
associated aortic regurgitation murmur.
- 95% have mitral regurgitation murmur, a quarter
of them have also have aortic regurgitation
murmur and 5% pure AR.
- The acute hemodynamic overload resulting from
acute mitral regurgitation and or AR leads to left
ventricular failure and is the main reason for
the morbidity and mortality of rheumatic
16. SUBCLINICAL CARDITIS: carditis may
occasionally be clinically silent and only
identified by echocardiography that shows
mitral regurgitation.
2. ARTHRITIS:
- it is an early manifestation, involves 30-50%
patients.
- rheumatic arthritis is a polyarthritis involving
large joints knees, ankles, elbows.
Uncommonly smaller joints may also be
involved.
- it is a migratory arthritis with the affected joints
showing redness, warmth, swelling ,pain and
limitation of movement. There is no residual
17. 3. Subcutaneous nodules:
- Occurs in about 3-20% of cases It is a late
manifestation and and appears around 6 weeks after
the onset of rheumatic fever. They last from few days
to weeks but can last upto 1 year.
- they are non tender and appear on bony
prominences like elbows, shins, occiput and spine.
- they vary in size from pinhead to an almond.
4. CHOREA:
- Syndenham’s chorea is also a late manifestation
occurring about three months after the onset of ARF.
- it consists of semipurposeful, jerky movements
resulting in deranged speech, muscular coordination,
awkward gait and speech. Child is emotionally
disturbed.
- self limiting course of two to six weeks. 3-4 times
common in females.
20. 5. ERYTHEMA MARGINATUM:
- it is an early manifestation, predominantly seen
over the trunk.
- it starts as a red spot with pale centre,
increasing in size to coalasce with adjacent spots
to form a serpiginious outline.
- rash is nonitching.
21.
22.
23. MINOR CRITERIA
CLINICAL CRITERIA:
1. FEVER: rheumatic fever almost always
associated with fever. Temperature rarely goes
above 39.5 C.
2. ARTHRALGIA: arthralgia and arthritis together
occur in about 90% of the patients. It is a
subjective pain.
3. PREVIOUS RHEUMATIC FEVER OR RHD:
this criterion applies only for recurrent episodes
of rheumatic fever.
LABORATORY MANIFESTATION:
1. ACUTE PHASE REACTANTS: the leukocyte
count usually lies between 10000 to
24. ESR is elevated during ARF and remains for 4-10
weeks in almost 80% patients.
C reactive protein is elevated in all patients and
subsides rapidly if the patient is treated with
corticosteroids. Its presence is nonspecific, while
absence is against the diagnosis of ARF.
2. PROLONGED PR INTERVAL: it is prolonged in
many infections and is not diagnostic of carditis.
Higher grades of block like second degree AV
block especially Wenckebachs type may be
seen.
25. ESSENTIAL CRITERIA:
1. ASO TITRE: these include evidence of recent
streptococcal infection. Elevated levels of ASO
indicate previous infection and not rheumatic
fever. A basal ASO titre of 50 u/dl that goes
upto 250 u/dl is indicative of recent infection.
Rising titre is a strong evidence.
2. ECHOCARDIOGRAPHY: the recent revision of
jones criteria includes echocardiographic
findings for the diagnosis of rheumatic carditis.
Features include annular dilation, elongation of
chordae to the anterior leaflet of the mitral valve
causing a prolapse and lack of coaptation of
the two leaflets resulting in mitral regurgitation.
This has lead to recognition of subclinical
carditis.
26. TREATMENT
Management is symptomatic combined with
suppressive therapy.
Bed rest: Bed rest is generally recommended for
ARF. Prolonged bed rest >2-3 weeks is seldom
necessary unless there is clinically apparent
carditis with heart failure.
Penicillin: after obtaining throat culture.
A single injection of benzathine penicillin is
given.
Penicillin V is an alternative. 250MG four
times a day for 10 days.
Erythromycin 250 MG four times a day for 10
days is given to penicillin allergy.
27. SUPPRESSIVE THERAPY:
Aspirin or corticosteroids are given as
suppressive therapy. Steroids are more potent
suppressive agent as compared to aspirin.
Following guidelines are used :
CARDITIS WITH CONGESTIVE CARDIAC
FAILURE: corticosteroids.
CARDITIS WITHOUT CONGESTIVE
CARDIAC FAILURE: either corticosteroids or
aspirin ; former preferred.
NO EVIDENCE OF CARDITIS: aspirin.
28. Total duration of therapy – 12 weeks.
Aspirin is given at a dose of 90-120 mg/kg/day
in four divided doses for 10 weeks and tapered
in next two weeks.
Prednisolone at a dose of 2mg/kg daily ;
maximum dose 60mg is given for three weeks
and then tapered gradually in next 9 weeks.
Surgical replacement of the mitral and/or aortic
valve is sometimes indicated ,if the patient is
deteriorating despite aggressive decongestive
measures.
29. Management of chorea:
the patient as well as the parents are reassured
about the self limiting course. The signs and
symptoms of chorea do not respond well to anti
inflammatory agents or steroids. Supportive
measures such as rest in quiet room,
medications such as haloperidol, diazepam, and
carbamazepine are effective.
30. Prevention of rheumatic fever:
PRIMARY PREVENTION:
It includes:
I. Prompt identification of sore throat
II. Rapid confirmation of a streptococcal
etiology
III. Treatment with penicillin.
SECONDARY PREVENTION:
It consists in giving long acting benzathine
penicillin. The dose is 1.2 million units once
every 3 weeks or 0.6 million units every
alternate week.
31. Patient without proven carditis should receive
prophylaxis for 5 years after the last episode or
until they are 18 year old (whichever is longer)
Patient with carditis – mild mitral regurgitation or
healed carditis should receive prophylaxis for 10
years after the last episode or till 25 years of age
(whichever is longer)
Patients with established RHD or following valve
surgery or balloon valvotomy should receive
lifelong prophylaxis.
Some cardiologists recommend discontinuation
of prophylaxis after the age of 40 years, since
the recurrence beyond this age is minimal.