Acute rhinosinusitis can be divided into common cold, post-viral rhinosinusitis, and acute bacterial rhinosinusitis (ABRS). ABRS is defined as having at least 3 symptoms including discolored discharge, severe local pain, and fever. Antibiotics are recommended as soon as ABRS is diagnosed. For initial treatment, amoxicillin-clavulanate is recommended over amoxicillin alone in both children and adults. Treatment duration is typically 5-7 days for adults and 10-14 days for children. Alternative management should be considered if no improvement within 3-5 days of initial antibiotics.
Complications of rhinosinusitis(Dr ravindra daggupati)Ravindra Daggupati
orbital complications of rhino sinusitis,intra cranial complications of rhino sinusitis,classification of complications,diagnosis and treatment of complications
Complications of rhinosinusitis(Dr ravindra daggupati)Ravindra Daggupati
orbital complications of rhino sinusitis,intra cranial complications of rhino sinusitis,classification of complications,diagnosis and treatment of complications
Base on a review paper "What dentists need to know about COVID-19" by Maryam Baghizadeh Fini on Oral Oncology 105 (2020) 104741. This paper was published in late May. This all we know now.
We all know how COVID is affecting all our lives, we see people getting themselves tested for the infection, we merely know what is the procedure and what are the tests done.
We all know the noble Coronavirus replicates some of its functioning and symptoms to that of the SARS virus. However, the SARS-CoV-2 virus has an e-gene which makes it envelope around the viral shell making the enzyme RNA dependent RNA Polymerase. It takes almost 24-48 hrs to get the results if the test confirms the person is COVID positive or negative.
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.
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.
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.
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
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.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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
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.
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.
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!
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
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.
2. EPOS: 2007 VS 2012
Content 2007 2012
Definition Divided into adult/children
Classification Acute non-viral rhinosinusitis Acute post viral
rhinosinusitis
Defined ABR
Epidemiology More study
Factor associated with ARS More evidence
Additional lab Mucocillary function Procalcitonin
Nasal airway assessment ESR
Algorithm and Transformation
Evidence of treatment
3. ARS in primary care studies
0.2 -1.8%
3.4 %
6-10%
Recurrent ARS: 0.035%
14%
EPOS March 2012
5. EPOS: Categories of Evidence
Ia: meta-analysis of RCTS
Ib: at least 1x RCT
IIa: at least 1x controlled study w/out
randomization
IIb: at least 1x other type of quasi-experimental
study
6. EPOS: Strength of Recommendations
A = directly based on category I evidence
B = directly based on category II evidence, or
extrapolated from category I evidence
C = directly based on category III evidence or
extrapolated from category I or II evidence
D = directly based on category IV evidence or
7. Acute rhinosinusitis in adults
Inflammation of nose and paranasal sinuses
≥ 2 symptoms, one of nasal blockage/
obstruction/congestion or nasal discharge (a
nt/post nasal drip):
± facial pain/pressure
± reduction or loss of smell
And either
EPOS March 2012
8. Acute rhinosinusitis in children
Inflammation of nose and paranasal sinuses
≥ 2 symptoms one of nasal blockage/
obstruction/congestion or nasal discharge (a
nt/post nasal drip):
± facial pain/pressure
± cough
And either
EPOS March 2012
9. Conventional Criteria for Diagnosis of Sinusitis
Based on Presence of at Least 2 Major or 1 Major and
2 Minor Symptoms
IDSA Guideline for ABRS: CID.March 20, 2012
10. Severity of disease in adult and
children
Define disease severity:
Mild: VAS 0-3
Moderate: VAS 4-7
Severe: VAS 8-10
EPOS March 2012
11. Classification of ARS in adult/
children
Common cold/ acute viral rhinosinusits :
duration of symptoms for< 10 d
Acute post-viral rhinosinusitis:
increase of symptoms after 5 d or persistent symptoms after 10 d wi
th < 12 wk duration.
ABS: ≥ 3 symptoms/signs
Discoloured discharge (unilat predominance) and purulent secretion in nasi
Severe local pain (unilat predominance)
Fever (>38 °C)
12. Natural history & time course of fever and RS symptom
associated with uncomplicated viral URI in children
IDSA Guideline for ABRS: CID.March 20, 2012
13. Acute rhinosinusitis can be divided into Common Cold
and post- viral rhinosinusitis. A small subgroup of post-viral
rhinosinusitis is caused by bacteria (ABRS).
14. Postviral acute rhinosinusitis Signs of ABS
At least 3 of:
Increase in symptoms after 5 d
-Discoloured d/c
-Severe local pain
-Fever
Persistent symptom after 10 d -Elevated ESR/CRP
-Double sickening
EPOS March 2012
15. I: Which clinical Presentations Identify
Acute Bacterial Vs Viral Rhinosinusitis ?
Onset with persistent S/S compatible with ARS ≥
10 d without any evidence of clinical improvement.
Onset with severe S/S of high fever ≥ 39 °C and
purulent nasal discharge or facial pain at least 3–4
consecutive d at beginning of illness.
Onset with worsening S/S characterized by new
onset of fever,IDSA Guideline for ABRS: CID.March 20, 2012 in nasal dischar
headache, increase
16. Factors associated with ARS
Environmental Exposures
Anatomical factors
Allergy
Ciliary impairment
Primary Cilia Dyskinesia
Smoking
Laryngopharyngeal reflux
EPOS March 2012
17. Environmental Exposures
Exposure to individual with respiratory
complaints was risk factor for RS
infection(adjusted OR = 3.7).
Increased levels of dampness in home has
been associated with sinusitis.
Exposure to air pollution, irritants used in
preparation of pharmaceutical products,
EPOS March 2012
18. Anatomical factors
Anatomical variations including Haller cells
and septal deviation, nasal polyps, and
choanal obstruction by benign adenoid tissue
, or odontogenic sources of infections.
EPOS March 2012
19. Ciliary impairment
Ciliary function diminished during viral and
bacterial rhinosinusitis.
Exposure to cigarette smoke and allergic
inflammation has been shown to impair ciliar
y function.
Impaired mucociliary clearance in AR
patients predisposes patients to ARS
EPOS March 2012
20. Smoking
Active smokers with on-going allergic
inflammation have increased susceptibility to
ARS compared to non-smokers with on-goin
g allergic inflammation, suggesting that expo
sure to cigarette smoke and allergic inflamm
ation is mediated via different and possibly s
ynergistic mechanisms.
EPOS March 2012
21. Laryngopharyngeal reflux
Pacheco-Galvan et al. 1997-2006 have shown
significant associations between GERD and
sinusitis.
Recent systematic review, Flook and Kumar
showed only poor association between acid
reflux, nasal symptoms, and ARS
EPOS March 2012
22. Anxiety and depression
Poor mental health, anxiety, or depression is
associated with susceptibility to ARS
Mechanisms are unclear.
EPOS March 2012
23. Drug resistance
Amoxicillin is the most commonly used
antibiotic for mild ARS.
Increasing resistance to amoxicillin,
particularly in S. pneumoniae and
H. influenzae infections.
EPOS March 2012
24. Concomitant Chronic Disease
Concomitant chronic disease (bronchitis,
asthma, CVS disease, DM, CA) in children has
been associated with increased risk of develo
ping ARS secondary to influenza.
EPOS March 2012
25. Microbiology of viral (common
cold), postviral, and bacterial ARS
Viruses.
Rhinoviruses (50%) and coronaviruses.
Influenza viruses, parainfluenza viruses,
adenovirus, RSV, enterovirus.
Bacteria.
S. pneumoniae, Haemophilus influenza,
M. catarrhalis and S. aureus.
Streptococcal species , anaerobic bacteria
EPOS March 2012
27. Bacteriology
Microbiological investigations are not
required for diagnosis of ARS in routine
practice.
May be required in research settings, or in
atypical or recurrent disease
EPOS March 2012
28. Prevalence (Mean Percentage of Positive Specimens)
of Pathogens From Sinus Aspirates in ABS
IDSA Guideline for ABRS: CID.March 20, 2012
29. XVI. Should Cultures Obtained by Sinus Puncture or
Endoscopy, Cultures of Nasopharyngeal Swabs Sufficient?
Cultures be obtained by direct sinus aspiration
rather than by nasopharyngeal swab (strong, mo
derate).
Endoscopically guided cultures of middle meatus
may be considered as alternative in adults, but th
eir reliability in children has not been established
(weak, moderate).
IDSA Guideline for ABRS: CID.March 20, 2012
30. C-Reactive Protein (CRP)
Raised in bacterial infection.
Limiting unnecessary antibiotic use.
ARS: low or normal CRP may identify low
likelihood of positive bacterial infection
CRP levels are significantly correlated with
EPOS March 2012
31. ESR
ESR levels correlated with CT changes in ARS
ESR >10 is predictive of sinus fluid levels or
sinus opacity on CT scan.
Raised ESR is predictive of positive bacterial
culture on sinus puncture or lavage
EPOS March 2012
32. Procalcitonin
More severe bacterial infection
There is no evidence of its effectiveness as a
biomarker in ARS.
EPOS March 2012
33. Nasal Nitric Oxide (NO)
Sensitive indicator of presence of
inflammation and ciliary dysfunction.
Very low levels: primary ciliary dyskinesia,
insignificant sinus obstruction.
Elevated levels: inflammation provided
ostiomeatal patency maintained.
EPOS March 2012
34. Nasal endoscopy
Nasal endoscopy may be used to visualize
nasal and sinus anatomy and to provide
biopsy and microbiological samples.
EPOS March 2012
35. Imaging
CT scan
Modality of choice to confirm extent of pathology
and anatomy.
Very severe disease, immuno-compromised pt,
suspicion of complications.
Routine CT scan in ARS little useful information
Plain sinus X Rays
EPOS March 2012
36. XVII. Which Imaging Is Most Useful for Severe ABRS
who suspected to have Suppurative complication?
CT rather than MRI is recommended to
localize infection and to guide further treatm
ent (weak, low).
IDSA Guideline for ABRS: CID.March 20, 2012
39. Management of ARS
ARS resolves without antibiotic treatment in
most cases.
Symptomatic treatment and reassurance is
the preferred initial management strategy fo
r patients with mild symptoms.
Antibiotic therapy should be reserved for
high fever or severeMarch 2012
EPOS (unilateral) facial pain.
41. II: When Should ATB Initiated
in Pt With S/S Suggestive of
ABRS? ATB be initiated as soon as clinical
Empiric
diagnosis of ABRS is established as defined in
recommendation 1 (strong, moderate)
IDSA Guideline for ABRS: CID. March 20, 2012
42. III: Should Amoxicillin Vs Amoxi-Clav
Used for Initial ATB of ABR in
Amoxi-clav rather than amoxicillin alone
Children?
recommended as empiric antimicrobial thera
py for ABRS in children
(strong, moderate).
IDSA Guideline for ABRS: CID.March 20, 2012
43. IV: Should Amoxicillin Vs Amoxi-
Clav used for Initial ATB of ABR in ad
ults?
Amoxi-clav rather than amoxicillin alone is
recommended as empiric ATB for ABRS in ad
ults
(weak, low).
IDSA Guideline for ABRS: CID.March 20, 2012
44. V: When Is High-Dose Amoxi-Clav
Recommended Initial ATB for ABR ?
‘‘High-dose’’ (2 g/d or 90 MKD bid) amoxi-clav
recommended for children and adults with ABRS
High endemic rates (≥10%) of DRSP
Severe infection
( systemic toxicity
IDSA Guideline for ABRS: CID.March 20, 2012
45. VI: Should quinolone Vs B-Lactam used
1°-line for Initial ATB of ABR?
B-lactam (amoxi-clav) rather than respiratory
fluoroquinolone recommended for initial
empiric antimicrobial therapy of ABR
(weak, moderate)
IDSA Guideline for ABRS: CID.March 20, 2012
46. VII: Besides quinolone, Should Macrolide, bactrim,
doxycycline, 2°/3° Gen Cep Used 2° -line for ABR?
Doxycycline may be used alternative in adults because it remains active against
RS pathogens and has excellent PK/PD (weak, low).
2°/3° oral Gen Cep: no longer recommended for empiric monotherapy of ABRS
due to resistance S. pneumoniae. Combination tx with 3° oral Gen plus clindamy
cin may be used as 2°-line for children with non–type I penicillin allergy or high en
demic rates of PNS S. pneumoniae (weak, moderate).
Not recommended
Macrolides: high rates of resistance S. pneumoniae (30%) (strong, moderate)
IDSA Guideline for ABRS: CID.March 20, 2012
47. VIII. Which ATB Recommended for ABRS
in Adults/Children with Penicillin Allergy?
Adults:
Either doxycycline or quinolone(levofloxacin/
moxifloxacin)
(strong, moderate)
Children:
Levofloxacin: type I hypersensitivity to penicillin
Clindamycin + 3° oral Gen Cep (cefixime/cefpodoxime):
non–type I hypersensitivity CID.March 20, 2012
IDSA Guideline for ABRS:
to penicillin
48. IX: Should Coverage for S. aureus Be
Provided Routinely during Initial Empiric ATB
of ABR?
S. aureus (including MRSA) is one of
potential pathogen in ABRS
Routine ATB coverage for S. aureus or MRSA
during initial empiric therapy of ABRS is not r
ecommended (stro
ng, moderate).
IDSA Guideline for ABRS: CID.March 20, 2012
49. X: Should empiric ATB be administered
for 5–7 d vs 10–14 d?
Uncomplicated ABRS in adults: 5–7 days
(weak, low-moderate).
Children with ABRS: 10–14 days
(weak, low moderate).
IDSA Guideline for ABRS: CID.March 20, 2012
50. XIV: How Long Should Initial Empiric ATB in
Absence of Clinical Improvement Be Continued Befo
re Considering Alternative Management?
Alternative management strategy is
recommended if symptoms worsen after 48–
72 hrs of initial empiric ATB or fail to improve
despite 3–5 d of initial empiric ATB
(strong, moderate)
IDSA Guideline for ABRS: CID.March 20, 2012
51. XV: What Is Recommended in Who Worsen Despite 72 Hr
or Fail to Improve After 3–5 D of Initial Empiric ATB?
Should be evaluated for possibility of
resistant pathogens, noninfectious etiology,
structural abnormality, or other causes for tre
atment failure
(strong, low).
IDSA Guideline for ABRS: CID.March 20, 2012
54. INS VS placebo for adults/children with ABS
IDSA Guideline for ABRS: CID.March 20, 2012
55. XII: Are INS Recommended as
Adjunct to ATB in ABR?
INS recommended as adjunct to ATB,
primarily in patients with history of AR
(weak, moderate)
IDSA Guideline for ABRS: CID.March 20, 2012
56. Oral corticosteroids adjunct
therapy
Cochrane analysis suggests that oral steroids
as adjunctive therapy to oral antibiotics are e
ffective for short-term relief of symptoms (he
adache, facial pain, nasal decongestion and) i
n ARS
Evidence level Ia
EPOS March 2012
57. Oral antihistamines
No indication for use of AH(both intranasal
and oral) in treatment of post viral ARS,
except in co-existing allergic rhinitis.
EPOS March 2012
58. Nasal decongestants
27 trials (5,117 participants) of RCT:
effectiveness of common cold treatments
AH, analgesic-decongestant combinations
have some general benefit in adults and older
children (recommendation A).
Weighed benefits against risk of adverse
effects. EPOS March 2012
59. XIII: Should Topical or Oral Decongestants or
AH Be Used as Adjunctive Tx in ABR?
Neither topical nor oral decongestants and/or
AH recommended as adjunctive treatment in
patients with ABRS (strong, low-moderate).
IDSA Guideline for ABRS: CID.March 20, 2012
60. Nasal or antral irrigation
Nasal douching with saline solution has
limited effect in adults with ARS (lev
el of evidence Ia).
Effective in children with ARS in addition to
standard medication (level of evidence Ib) an
d can prevent recurrent infections (level
of evidence IIb)
EPOS March 2012
61. XI: Is Saline Irrigation of Benefit as
Adjunctive Tx in ABR?
Intranasal saline irrigation(physiologic /
hypertonic saline) recommended as an adjun
ctive treatment in adults with ABRS (weak, lo
w-moderate).
IDSA Guideline for ABRS: CID.March 20, 2012
62. Heated, humidified air
Steam may help congested mucus drain
better and heat may destroy cold virus as it d
oes in vitro.
Steam inhalation has not shown any
consistent benefits in treatment of common
cold, hence is not recommended in routine tr
eatment of common cold symptoms
EPOS March 2012
63. Interventions to interrupt spread
of viruses in viral rhinosinusitis
Handwashing, esp around younger children.
Incremental effect of adding antiseptics to
normal handwashing to decrease respiratory
disease remains uncertain.
Barriers to transmission, isolation, hygienic
measures are effective at containing RS virus
epidemics. EPOS March 2012
65. Probiotics
Probiotics were better than placebo in
reducing number of acute URTIs, rate ratio of
and reducing antibiotic use
Recommendation A
EPOS March 2012
66. Vaccination
No direct effect in treatment of ARS.
Affected frequency and bacteriology of AOM
and ABS
Causative pathogens of ABS in children in 5 y
after introduction vaccination PCV7 as
compared to previous 5 y. Proportion of
S. pneumoniae declined by 18%, H.influenza
EPOS March 2012
67. NSAID’s, Aspirin or
acetominophen
NSAID did not significantly reduce TSS, or
duration of colds.
Outcomes related to analgesic effects of
NSAID (headache, ear pain, muscle, jt pain).
No evidence of increased frequency of
adverse effects in NSAID tx groups.
EPOS March 2012
68. Zinc
Zinc would shorten duration of episode of
common cold and prevention risk of developi
ng episode of common cold.
Too early to give general recommendations
for use of zinc because not sufficient knowle
dge optimal dose, formulation and duration o
f treatment
EPOS March 2012
European Position Paper on Rhinosinusitis and Nasal Polyps Infectious Diseases Society of America
Prevalence: 6-15% of population ABS: 0.5-2.0% of pt
Prevalence of ARS of 1.4% reported in 292 pt of URI at Siriraj Hospital. April- October 200 Treebupachatsakul P et al. J Med Assoc Thai. 2006.Aug;89(8):1178-86. This low prevalence may be due to majority of pts with ARS presenting to their primary care provider rather than hospital
following clinical presentations(any of 3) are recommended for identifying patients with acute bacterial vs viral rhinosinusitis:
ABR Who Has Failed to Both 1°&2° line , should Cultures to Document Persistent/Resistant Bacterial Pathogens.
Cochrane analysis, 4DBPC studies with total of 1,943 pt support use of INS as monotherapy or adjuvant tx to ATB(evidence level Ia). Higher doses of INS had stronger effect on improvement or complete relief of symp; for MF 400 μg vs 200 μg, (RR 1.10; 95% CI 1.02-1.18 vs RR 1.04; 95% CI 0.98-1.11). No significant adverse events reported and no significant difference in drop-out and recurrence rate for 2 tx gr.
Severe=high fever or unilat facial pain
*1b(-): 1b study with negative outcome $ Ia(-) Ia level of evidence that treatment is not effective. **A(-): grade A recommendation not to use สมุนไพรอิชิเนเซีย (echinacea) ใช้ป้องกันรักษาหวัดและไข้หวัดใหญ่ เหมือนเดิม : oral ATB, topical steroid, oral ATB and topical steroid, decongestion, mucolytic, oral AH ต่าง : 2012 มี oral steroid เป็น grade A, combination AH analgesic-decongestion gr A, Ipratopium bromide gr A, protbiotic gr A, herbal medicine, ASA, paracetamol A- steam inhalation cromoglycate Zinc c, vit C C, echinacea C Saline irrigate D เป็น A
เหมือนเดิม : oral ATB, topical steroid + ATB, saline irrigate ต่าง : topical steroid D เป็น A topical decongestant C เป็น D mucolytic A- AH D