A Therapeutic topic on Urinary Tract Infection, covering various subtopics like the causative organism, clinical features and more importantly, the laboratory diagnosis.
This presentation covers Urinary tract Infections (UTI). Their Definition, forms, epidemiology, risk factors, etiology, Clinical manifestation, Diagnostic procedures, Management, Complications and Education to the Patients are discussed in detail.
Presentation at the SRMO weekly teaching for Shellharbour Hospital ED - by Dr Mahsa Fateminayyeri, MD - trainee, who covers an approach to sepsis in the ED setting, and highlights the value of a sepsis pathway to expedite antibiotic treatment and provide early resuscitation in order to promote good outcomes
A Therapeutic topic on Urinary Tract Infection, covering various subtopics like the causative organism, clinical features and more importantly, the laboratory diagnosis.
This presentation covers Urinary tract Infections (UTI). Their Definition, forms, epidemiology, risk factors, etiology, Clinical manifestation, Diagnostic procedures, Management, Complications and Education to the Patients are discussed in detail.
Presentation at the SRMO weekly teaching for Shellharbour Hospital ED - by Dr Mahsa Fateminayyeri, MD - trainee, who covers an approach to sepsis in the ED setting, and highlights the value of a sepsis pathway to expedite antibiotic treatment and provide early resuscitation in order to promote good outcomes
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
Information about Abdominal sepsis and peritonitis final by Dr Dhaval Mangukiya.
Details of Anatomy, intra abdominal infections, physiology, peritonitis, risks for failure of source control, management of critical issues.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Inflammatory bowel disease in history, different investigations and surgery and post op by Dr Dhaval Mangukiya.
Details of Low Anterior Resection(LAR), Arterial Supply, Venous Drainage, Ports, Position, Modified Lithotomy, Vessel Ligation, Lymph Nodes, Nerves Anatomy, Superior Hypogastric Plexus, Lateral Pelvic Nerves, Correct TME, Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
Information about Abdominal sepsis and peritonitis final by Dr Dhaval Mangukiya.
Details of Anatomy, intra abdominal infections, physiology, peritonitis, risks for failure of source control, management of critical issues.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Inflammatory bowel disease in history, different investigations and surgery and post op by Dr Dhaval Mangukiya.
Details of Low Anterior Resection(LAR), Arterial Supply, Venous Drainage, Ports, Position, Modified Lithotomy, Vessel Ligation, Lymph Nodes, Nerves Anatomy, Superior Hypogastric Plexus, Lateral Pelvic Nerves, Correct TME, Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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2. Approach to Acute Febrile Illness
• Definition: Rectal temperature ≥ 38.3°C, < 1 week
• History: Physical examination
• Pattern of fever and Length of illness
• Localizing symptoms
• Immunization status
• Prior use of medication
• Underlying disease
• Travel, contacts, animal and insect exposure
3. Management of Fever without source
• Infants 0 to 28 days of age
• Infants 29 to 90 days of age
• Infants 3 to 36 months of age
• Children aged 3 years to adulthood
4. Infants 0 to 28 days of age, Temp ≥ 38oC
• Infants 3 to 28 days old with temp. ≥ 38 oC 254 cases
• 32 (12.6%) had an Serious bacterial illness (SBI)
Arch Pediatr Adolesc Med. 1999 May;153(5):508-11.
5. Infants 0 to 28 days of age, Temp ≥ 38oC
• Sepsis work up:
• CBC, LFTs, Blood culture
• Urinalysis, Urine culture
• Lumbar puncture:
• HSV PCR if CSF pleocytosis
• Chest X Ray
• Viral study
6. Infants 0 to 28 days of age, Temp ≥ 38oC
Bacterial pathogens
• group B
streptococcus
• E.coli
• L.monocytogenes
Empirical antibiotics
• Ampicillin plus Gentamicin
• Ampicillin plus Cefotaxime
• Vancomycin
(gram positive on CSF gram
stain or risk for S.aureus)
Empirical acyclovir
• if risk factors for HSV disease
exist
7. Infants 29 to 90 days of age, Temp ≥ 38oC
Well – appearing Ill – appearing
8. Infants 29 to 90 days of age, Temp ≥ 38oC
Ill – appearing
Admit & Sepsis work up &
Parenteral antibiotic
Pathogens
• Neonatal pathogens
• H.influenzae, N.meningitides
• S.pneumoniae
Cefotaxime + Ampicillin
9. Infants 29 to 90 days of age, Temp ≥ 38oC
Well – appearing
Low – risk criteria
Outpatient management
YES
Clinical criteria
• Previously healthy
• No focal bacterial infection
Laboratory criteria
• WBC 5000 to 15000/mm3
• Band < 1500/mm3
• Normal UA
• Normal CSF, Stool exam
• (if obtained)
10. Infants 29 to 90 days of age, Temp ≥ 38oC
Low risk criteria Outpatient management
• Blood culture
• Urine culture
• Treat suspected influenza
Option 1
• Lumbar puncture
• Ceftriaxone 50 mg/kg IV/IM
• Reevaluation in 24 hours
Option 2
• No antibiotics
• Reevaluation in 24 hours
11. Infants 3 to 36 months of age, T ≥ 39oC
Well – appearing Ill – appearing
12. Infants 3 to 36 months of age, T ≥ 39oC
Ill – appearing
Sepsis work up
• Blood culture
• Urine culture
• Lumbar puncture (meningitis is suspected)
• Chest X Ray
(tachypnia & WBC > 20,000/mm3)
13. Infants 3 to 36 months of age, T ≥ 39oC
Ill – appearing
Sepsis work up
Parenteral antibiotic
Pathogens
• H.influenzae type B
• N.meningitides
• S.pneumoniae
• S.aureus
Ceftriaxone & Cefotaxime
14. Infants 3 to 36 months of age, T ≥ 39oC
Well – appearing
Complete
Incomplete
15. Occult Bacteremia
• Bacteria in the blood
• Well – appearing febrile child
• Absence of an identifiable focal bacterial source
17. Pathogenic bacteria cultured from patients with occult bacteremia
1. Arch Pediatr Adolesc Med.
1998;152:624-628.
2. Pediatrics. 2000 Sep;106(3):505-11.
18. Evaluation of febrile young infants
• Boston
• Philadelphia
• Rochester
• Lab-score
• Step by step
19. Boston protocol
• Prospectively evaluated 503 28- to 89-day-old infants with rectal
temperature greater than 38ºC (100.4ºF)
• Criteria:
• No immunizations or antimicrobials within the preceding 48 hours
• No evidence of dehydration, ear, soft tissue, or bone infection
• Overall well appearance
• Caretaker available by telephone
• The laboratory criteria defining low-risk patients included:
• Peripheral white blood cell (WBC) count less than 20,000/microL
• CSF with WBC <10/microL
• UA <10 WBC per high-powered field
• No infiltrate on chest radiograph if one was obtained
• Ceftriazone 50 mg/kg im, F/U 24 hr
• 27 (5.4%) had SBI
20. Philadelphia protocol
• 8-year experience with 747 infants 29- to 60-days of age with a rectal
temperature ≥38.2ºC (100.8ºF)
• Low-risk criteria included patients who were well-appearing with:
• WBC <15,000/microL
• Band-neutrophil ratio <0.2
• UA <10 WBC/hpf and a negative urine Gram stain
• CSF <8 WBC/microL and a negative CSF Gram stain
• Chest radiograph lacking an infiltrate if one was obtained
• Stool without blood and few or no WBCs on the smear in infants with
diarrhea
D/C and F/U 24 hr
Sensitivity 98 %(95% CI 92-100); specificity 42 %(95% CI 38-46);
PPV 14 %(95% CI 11-17); NPV 99.7 %(95% CI 98-100)
21. Rochester protocol
• Identify low-risk febrile infants (defined as a rectal temperature
greater than or equal to 38.0ºC or 100.4ºF) younger than 60 days
• Clinical criteria:
• ≥37 weeks gestation, and hospitalized no longer than the mother
• Infant was previously healthy
• Infant was well-appearing, with no ear, soft tissue, or bone infections
• LAB:
• WBC 5,000 to 15,000/microL with an absolute band count <1,500/microL
• Urinalysis with <10 WBC/hpf and no bacteria seen
• Stool with <5 WBC/hpf if obtained D/C with F/U
Five had SBI, NPV 98.9 %(95% CI 97-100)
24. • IBI 79.3% (22/26
sepsis, 9/10
meningitis)
• Non IBI 98.5%
25.
26.
27. Infants 3 to 36 months of age, T ≥ 39oC Well – appearing
Immunization incomplete
WBC ≥ 15,000/mm3 H/C
WBC > 20,000/mm3 CXR
CBC, UA, Urine culture
28. Infants 3 to 36 months of age, T ≥ 39oC Well – appearing
Immunization incomplete
WBC ≥ 15,000/mm3
CBC, UA, Urine culture
• Ceftriaxone (50 mg/kg/dose) IM
• Outpatient follow up within 24 hrs
• Admit for parenteral antibiotic
29. Antimicrobial treatment of occult bacteremia: a
multicenter cooperative study.
Children 3 to 36 months, T ≥ 39.5oC without focus of infection
WBC < 15,000/mm3 WBC ≥ 15,000/mm3 WBC ≥ 30,000/mm3
H/C positive 5 of
182, 2.7%
H/C positive 55 of
331, 16.6%
H/C positive 9 of 21,
42.9%
Pediatr Infect Dis J. 1993 Jun;12(6):466-73.
30. Occult pneumonias: empiric chest radiographs in
febrile children with leukocytosis
CXR were obtained in 225 cases
With respiratory
symptom, 79 case
With leukocytosis ≥
20,000/mm3, 149 cases
Pneumonia, 32 of 79 (40%) Pneumonia, 38 of 146 (26%)
Ann Emerg Med. 1999 Feb;33(2):166-73.
31. Infants 3 to 36 months of age, T ≥ 39oC Well – appearing
Immunization complete
Sign & Symptoms of UTI
• Girls < 24 mo of age
• Uncircumcised boys < 12 months of age
• Circumcised boys < 6 months of age
UA, Urine culture
NO YES
34. Managment
• ATB
• Upper UTI or fever 7-14 d
• Cystitis 3-7 d
• 1st UTI U/S KUB, not recommend routine VCUG if U/S normal
• Recurrent UTI U/S KUB, VCUG if not done before
35.
36. Antibiotics prophylaxis
• Not recommend routine ATB prophylaxis in 1st UTI
• Consider in patient that has to do VCUG
• High-grade reflux and underlying obstructive/complex uropathies
37. Renal abscess • Pyelonephrosis
• accumulation of purulent debris and
sediment in the renal pelvis and urinary
collecting system
• Symptoms: severe pyelonephritis,
persistent + signs of hydronephrosis
• ATB + drainage
• Acute focal bacterial nephritis (acute lobar
nephronia)
• intermediate stage between pyelonephritis
and intrarenal abscess
• CT: lobar or wedge-shaped, distribution of
hypointensity lesions
• ATB 14-21 days
38. • Perinephric or renal abscess
• Hematogenous seeding especially
Staphylococcus aureus BSI or renal
extension of ascending UTIs
• Severe pyelonephritis – fever, flank pain,
leukocytosis, and sometimes BSI
• CT: perirenal fluid or gas, renal distortion
• S. aureus, gram-negative bacilli (GNB)
(especially Escherichia coli and other
enteric GNB)
• Previous abdominal surgery, renal
transplantation, malignancy, and oral or
dental infection anaerobe
• ATB 2-3 wks + drainage
• Xanthogranulomatous pyelonephritis
• chronic bacterial pyelonephritis and
obstruction
• Age < 8 years, > 40 years
• DDx renal tumor
• Flank pain, fever, chills, and chronic
bacteriuria; vague symptoms such as
malaise, malnutrition, weight loss, and
failure to thrive, usually > 1 mo
• Proteus species, E. coli
• Obstruction is present in 70% to 80% of
children ( congenital genitourinary
anormality, renal calculi)
39. Children aged 3 years to Adulthood
• The incidence of occult bacteremia decreases after 3 years of
age