This document discusses antibiotic use and treatment for respiratory infections. It notes that 70% of antibiotics are prescribed inappropriately. For acute sinusitis, antibiotics are only recommended if symptoms persist for over 7 days without improvement from decongestants. For acute pharyngitis, antibiotics are only recommended if a strep test is positive. It provides treatment guidelines for various respiratory infections such as bronchitis, pneumonia, and those occurring in patients with COPD or asthma. It emphasizes the importance of judicious antibiotic use and treating viral causes symptomatically.
Aula ministrada pelo Prof. Dr Angelo Casalini no dia 09/05/12 no I Simpósio Brasil-Itália, sediado no Hospital Universitário João de Barros Barreto (UFPA - Belém).
Aula ministrada pelo Prof. Dr Angelo Casalini no dia 09/05/12 no I Simpósio Brasil-Itália, sediado no Hospital Universitário João de Barros Barreto (UFPA - Belém).
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
Recurrent UTI: three febrile UTIs in six months or four total UTIs in one year.
8 to 30 percent of children with UTI experience on or more reinfections. Recurrent episodes of pyelonephritis can lead to renal scarring.
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
Recurrent UTI: three febrile UTIs in six months or four total UTIs in one year.
8 to 30 percent of children with UTI experience on or more reinfections. Recurrent episodes of pyelonephritis can lead to renal scarring.
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.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- 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
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.
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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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.
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
2. ¿CUÁNTO REDUJERON LA MORTALIDAD LOS
ANTIBIÓTICOS?
Redujeron la mortalidad en
aprox. 220 / 100.000
habitantes.
3. ¿ Sirve para algo prescribir antibióticos
“por las dudas” ?
Rino-sinusitis Aguda
Numero Necesario a Tratar con antibióticos para
acelerar una curación: 1 / 18
Número Necesario a Dañar al tratar con
antibióticos:
1 / 8
I
NFECCIONESRESPIRATORIAS
4. ¿Cuáles son los agentes etiológicos?
VIRUS > 95 % rinosinusitis, > 90 % bronquitis, >60 % Anginas, y
solo 6% neumonías.
Streptococcus pneumoniae
Streptococcus piogenes
Streptococcus β hemolítico grupo A
Haemophilus influenzae
Moraxella catarrhalis
Chamydophila pneumoniae
Mycoplasma pneumoniae
Bordetella pertusis
Staphylococcus aureus
Gram +
Gram +
Gram +
Gram - cocobacilo
Gram + coco
Gram - intracelular
Gram – anaerobiofacultativo
Gram -
Gram +
I
NFECCIONESRESPIRATORIAS
5. RESFRÍO COMÚN
AGENTES CAUSALES
• Rinovirus (100 serotipos) 50 %Parainfluenza, Adenovirus, Virus
Sincitial respiratorio, Echovirus…. Coronavirus!!!!
• Tratamiento no farmacológico
• Reducir complicaciones: Asmáticos y EPOC
• Mejorar los síntomas y Acortar la evolución: Solución salina local
para la obstrucción nasal (niños).
• Inhalaciones con vapor de agua
• Farmacológico: Nunca administrar antibióticos!!!
Analgésicos, Paracetamol
• Descongestivos: Pseudoefedrina 120 mg/12 hs VO,
• Gotas nasales: No más de 3 días. Reducen los síntomas.
6. FARINGITIS AGUDA
⦿ Uso irracional de antibióticos. Generalmente son
procesos virales (rinovirus, influenza,
parainfluenza, VSR, Ebstein Bar, Enterovirus,
Herpes, CORONAVIRUS!!)
⦿ TTO sintomático con AINE. Corticoides sistémicos y
anestésicos tópicos (BII) exceso aumentan efectos
adversos
⦿ 15% Estreptococo beta hemolítico Grupo A
(EBHGA) (2da infancia, mas frecuente).
⦿ Criterios diagnósticos de Centor
8. FARINGITIS AGUDA
Tratamiento antibiótico:
• Penicilina 500000 U/kg/dia menos de 27 kg / 12 hs
por 10 dias.
750000 U en mas de 27 kg.
Alérgicos a penicilina:
• Eritromicina 250 mg / 6 hs VO por 10 días .
• A las 48 hrs de tratamiento ya no contagia y debe
haber desaparecido la fiebre.
2° Línea de tto: Amoxicilina 500 mg / 8 hs VO 10 días
Azitromicina 500 mg VO / día 5 días
Claritromicina 250 mg / 12 VO 10 días
Clindamicina 300 mg / 12 hs 10 días
9. OTITIS MEDIA AGUDA
Más frecuentes en pacientes que cursan cuadro infeccioso del tracto
respiratorio superior con congestión e inflamación de la mucosa nasal,
nasofaringe y trompa de Eustaquio.
⦿ Gérmenes: S pneumoniae, Haemophilus, Moraxella y virus.
⦿ Tratamiento antibiótico: Amoxicilina 1500 mg/día ,vía oral
administrada en dos o tres dosis diarias por 10 días.
⦿ Alérgicos: Claritromicina 250 mg/ 12 hs por 10 días.
⦿ La fiebre y el dolor deben desaparecer en 2 a 3 días.
2° Línea de tto: Amoxicilina clavulánico 500 mg / 8 hs por
10 días.
Azitromicina 500 mg VO / día 5 días
⦿
10. SINUSITIS BACTERIANA AGUDA
Evento precipitante infección viral. Sobre diagnóstico
frecuente. Síntomas dolor facial, cefalea y fiebre.
Criterio Clínico: Regla predictiva de Williams.
1 Dolor maxilar, dental o facial
2 Sin mejoramiento sintomático con descongestivos
3 Secreciones mucopurulentas en el examen físico.
4 Transiluminación anormal de los senos paranasales.
5 Descarga nasal con cambio de color de las secreciones.
• Mas de 4 criterios aproximan el diagnóstico de etiología
bacteriana con una probabilidad superior al 81%.
• Menos de 2, descartan etiología bacteriana. Entre 2 y
4 recomiendan evaluación radiológica.
12. ⦿ Cuando dar Antibiótico?
Cuando los síntomas perduran por mas de 7 días y sin
respuesta a descongestivos.
TRATAMIENTO
13. TRATAMIENTO
⦿ Cuando dar Atb?
Cuando los síntomas perduran por mas de 7 días y sin
respuesta a descongestivos.
TRATAMIENTO
14. LARINGITIS,
LARINGOTRAQUEITIS
⦿ Etiología viral: parainfluenza, Rinovirus, adenovirus e
influenza.
⦿ No hay evidencia de la utilidad de antitusivos.
expectorantes, mucolitícos o antihistamínicos.
⦿ No esta recomendado el uso de ATB, por ser de
etiología viral.
15. BRONQUITISAGUDA
⦿ 70% reciben antibiótico innecesariamente, etiología viral
influenza A y B, parainfluenza, coronavirus, rinovirus, VRS y
metapneumovirus humano
Primera causa de indicación de antibióticos innecesaria
• Tos de ≤ 3 semanas productiva el 50 % de las veces, amarillo o
verde es por reacción inflamatoria.
• Compromiso moderado de la vía aérea superior.
• Fiebre ≤ 3 día s de evolución.
• Escaso compromiso general. Pulso ≤ 100, f resp ≤ 24. (menores
de 70 años).
• Auscultación pulmonar normal o sibilancias aisladas.
• RX realizar en edad avanzada, sospecha de Neumonía, o IC,
EPOC,TBC e inmunosuprimidos.
16. TRATAMIENTO SINTOMÁTICO
⦿ Corticoides asociado a Epoc.
⦿ No prescribir antitusivos.
⦿ N-Acetilcisteína: Ninguna guía la aprueba. RAM:
broncoespasmos.
18. INFECCIONES RESPIRATORIAS EN
PACIENTES CON EPOC
⦿
⦿
⦿
⦿
Exacerbaciones:
50% Haemophilus, Neumoco, Moraxella y Pseumonas
30% virus
20% Clamidias y Micoplasma
EPOC leve a moderado. Tto ambulatorio reevaluados a las 48 a72 hrs.
EPOC con FEV1 mayor a 50%:amoxicilina-clavulánico, ceftriaxona
o levofloxacina
⦿
⦿
EPOC con FEV1 menor a 50%:
Sin riesgo de infección por Pseudomona: Levofloxacina, amoxicilina
clavulanico por 5 a 7 días.
Con riesgo: Levofloxacina, Ciprofloxacina. Betalactámico activo contra
Pseudomonas: Cefepima,Ceftazidima,Piperacilina_ Tazobactan,
Imipenem o Meropenem dirante 10 días.
19. INFECCIONES RESPIRATORIAS EN
PACIENTES CON ASMA
⦿ Las infecciones agudas asociadas son
habitualmente de etiología viral, por Influenza y
Rinovirus.
⦿ Tanto pacientes con EPOC o ASMA deben
vacunarse contra la gripe, y contra el
Pneumococo.!!!!!
20. NEUMONÍA ADQUIRIDA DE LA
COMUNIDAD
“Infección aguda del parénquima pulmonar de origen
infeccioso con signos de infección respiratoria baja
(taquipnea – disnea - tos – expectoración – dolor torácico –
fiebre con o sin auscultación patológica) asociado a un nuevo
infiltrado en la radiografía de tórax, en un paciente NO
hospitalizado en los 14 días previos”.
MSN 2010
21. NEUMONÍA ADQUIRIDA DE LA
COMUNIDAD
6ª Causa de muerte en general
5ª Causa de muerte en mayores de 65 años
La principal causa de muerte, en la infancia, por
enfermedad respiratoria, es la NEUMONIA
22. NEUMONÍA ADQUIRIDA DE LA
COMUNIDAD CUANTIFICACIÓN DEL
RIESGO DE MORTALIDAD:
Confusión.
Uremia mayor a 90 ml dl Frecuencia Respiratoria mayor a 30.
TAS menor de 90 o TAD menor de 60 Edad mayor o igual a 65
CURB_65….posibilidad de muerte
⦿
⦿
⦿
🞄
Puntaje
0
1
2 (Internar)
3 o 5
Mortalidad
< 0,7
< 2,1 %
9,2 %
15 a 40%
24. TRATAMIENTO
⦿ Objetivo: Reducir MORBI – MORTALIDAD
Paciente: Ambulatorio , CURB 65 = 0
Sat O2 ≥ 94 %.
Sin co-morbilidad: EPOC, tabaquismo, asma,
diabetes:
AMOXICILINA 1000 mg / 12 hs o 500 mg / 8 hrs
por via oral por 5 a 7 días.
⦿
25. TRATAMIENTO
⦿
⦿
Alérgicos a la amoxicilina:
Eritromicina 500 mg cada 6 horas o
Claritromicina 500 cada 12 hrs.
Mayores a 65 años o menores con comorbilidades
Amoxicilina/clavulanato 875/125 cada 8 o12 horas vía oral
Amoxicilina/ sulbactán misma dosis y frecuencia
Ceftriaxona 1 g/ 24 hrs EV, no usar en alérgicos a penicilina.
⦿
⦿
Alérgicos a penicilina utilizar levofloxacina750 mg / 24hrs.
Precaución en: insuficiencia renal. Enfermedades del SNC,
Ancianos, ruptura tendón de Aquiles, confusión.
26. TTO: NUNCA DE PRIMERA ELECCIÓN
⦿ AZITROMICINA: Alta resistencia de neumococo. Baja
concentración plasmática.
⦿ DOXICICLINA: Alta resistencia de neumococo.
⦿ FLUOROQUINOLONAS: Rápido desarrollo de resistencia.
Tratamiento de 2° línea o alto riesgo.
27. TRATAMIENTO
CURB 65 ≥2 Edad ≥ 65 años Hipoxemia
Intolerancia VO Fumadores EPOC Insuficiencia cardíaca
Diabetes Alcoholismo crónico Insuficiencia renal crónica
Cáncer
INTERNAR!!!!!
Ampicilina sulbactam 1500 mg/6 h
Claritromicina 500 mg / 12 hs
Ceftriaxona 1000 / d
Levofloxacina 750 / día
Moxifloxacina 400 / día
⦿ Virus Influenza: Oseltamivir 75 mg cada 12hrs
28. PARA TERMINAR..
⦿ ETI…..pandemia Gripe AH1N1 concluyó año
2010, en agosto de ese año, según la OMS.
⦿Actualmente seguimos sufriendo
Pandemia por COVID19…..Año 2021.
⦿Reflexión:
Patologías prevenibles, si existe aislamiento,
MEDIDAS DE HIGIENE, sentido común y respeto
a las INSTITUCIONES CIENTÍFICAS.
