The document provides guidance on poisonings in pediatric patients, noting the most common types of exposures include cosmetics, cleaning substances, analgesics, and plants. It describes approaches to assessing and managing poisoned patients, including identifying toxidromes based on symptoms, performing toxicology screening when helpful, and employing decontamination methods or antidotes to treat specific poisonings. Guidelines are offered on evaluating patients, looking for signs of organ dysfunction, and initiating supportive care or enhanced elimination techniques as appropriate for the suspected toxin.
Chronic Liver Disease in pediatric: a case presentation and discussionDr Abdalla M. Gamal
A presentation from a tutorial about an interesting case that came to the Pediatric Department of Sebha Medical Center and was imaged by the Radiology Department.
The tutorial was a joint effort between Dr Zeinab Salem Ali (from Pediatric Department) and me (from Radiology Department). In her slides, Dr Zeinab presented the case history, examination, investigations, differential diagnosis and discussed the clinical presentation, investigations and management for chronic liver diseases in pediatric patients.In my slides, I discussed the definition, etiology, natural history of this condition and explained the role of imaging in its diagnosis.
These are my slides after some modifications. I added an aknowlegement page to illustrate Dr Zeinab effort and to thank Dr Khaled Aljasem from Pediatric Department for his effort in revising the original presentations and the constructive feedback he provided which improved the quality of the presented material. Then I added a summary for the parts Dr Zeinab has presented to make this powerpoint presentation complete.
This presentation was presented by Dr Zeinab Salem (from Pediatric Department) and me in a joint tutorial between Pediatric Department and Radiology Department of Sebha Medical Center.
Chronic Liver Disease in pediatric: a case presentation and discussionDr Abdalla M. Gamal
A presentation from a tutorial about an interesting case that came to the Pediatric Department of Sebha Medical Center and was imaged by the Radiology Department.
The tutorial was a joint effort between Dr Zeinab Salem Ali (from Pediatric Department) and me (from Radiology Department). In her slides, Dr Zeinab presented the case history, examination, investigations, differential diagnosis and discussed the clinical presentation, investigations and management for chronic liver diseases in pediatric patients.In my slides, I discussed the definition, etiology, natural history of this condition and explained the role of imaging in its diagnosis.
These are my slides after some modifications. I added an aknowlegement page to illustrate Dr Zeinab effort and to thank Dr Khaled Aljasem from Pediatric Department for his effort in revising the original presentations and the constructive feedback he provided which improved the quality of the presented material. Then I added a summary for the parts Dr Zeinab has presented to make this powerpoint presentation complete.
This presentation was presented by Dr Zeinab Salem (from Pediatric Department) and me in a joint tutorial between Pediatric Department and Radiology Department of Sebha Medical Center.
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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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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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
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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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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
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2. What is a poison?
▪ In common usage - poisons are
chemicals or chemical products
that are distinctly harmful to
human
▪ More precisely - a poison is a
foreign chemical (xenobiotic) that
is capable of producing a harmful
effect on a biologic system
3. Most common Pediatric Exposure
Cosmetics and personal care products (13%)
Cleaning substances (10%)
Analgesics (7.8%)
Foreign Bodies (7.4%)
Topicals (7.4%)
Cold and Cough Preparations (5.5%)
Plants (4.6%)
Pesticides (4.1%)
4. May be difficult because of non-specific symptoms
High index of suspicion - especially occult poisoning
▪ history may be unreliable
▪ look for corroborative history - missing pills, empty
container
Course that a poison runs (toxidromes) ! - may help
Toxicology screening - helpful only in a few
5. ▪ It is the association of several clinically
recognizable features, signs, symptoms,
phenomena or characteristics which often occur
together, so that the presence of one feature
alerts the physician to the presence of the
others.
6.
7.
8.
9.
10. S alivation *D iaphoresis/diarrhea
L acrimation *U rination
U rination *M iosis
D efecation *B radycardia/bronchospasm
G I secrestion/upset *E mesis
E mesis *L acrimation excess
*S alivation excess
11.
12. Hot as a hare
Dry as a bone
Red as a beet
Mad as a hatter
Blind as a bat
bowel, bladder
lose their tone, &
heart runs alone
13. Hot as a hare
Dry as a bone
Red as a beet
Mad as a hatter
Blind as a bat
bowel , bladder lose
their tone, &
heart runs alone
14. Hot as a hare
Dry as a bone
Red as a beet
Mad as a hatter
Blind as a bat
bowel , bladder
lose their tone,
&heart runs alone
31. Very diverse and varied - depends on the poison
Clinical examination should be focused on the
possible manifestations of common poisons in the
geographical area
37. Treat the patient, not the poison
Assess
General appearance
Work of breathing
Circulation
ABCDs
IV access and monitors
High Suspicion
59. ECG
Digoxin toxicity
TCA overdose - sinus tachycardia, QT prolongation,
increased QRS
Beta-blockers - conduction abnormalities
Imaging
. CXR- hydrocarbon ingestion
.Abdominal X-ray-- iron ingestion & radioopaque
ingestion.
.Oesophagoscopy -for caustic ingestion.
. Abdominal usg- recently been used as a means of
identifying presence of pharmaceutical material in GIT.
60. Opiates
Cocaine metabolite
Amphetamine
Benzodiazepines
Barbiturates
* No urine screen can confirm intoxication, only exposure
61.
62.
63. Reduce absorption of the toxin
Enhance elimination
Neutralise toxin
64.
65. Removal from surface skin & eye
Emesis induction
Gastric lavage
Activated charcoal administration & cathartics
Dilution - milk/other drinks for corrosives
Whole bowel irrigation
Endoscopic or surgical removal of ingested chemical
66. Skin decontamination
▪ Important aspect – not to be neglected
▪ Remove contaminated clothing
▪ Wash with soap and water (soaps
containing 30% ethanol advocated)
▪ However, no evidence for benefit even in OP
poisoning
67. Gastric decontamination
▪ Forced emesis if patient is awake
▪ Gastric lavage
▪ Activated charcoal 25 gm 2 hourly
▪ Sorbitol as cathartic
68. Gastric lavage
▪ Gastric lavage decreases absorption by 42% if done 20
min and by 16% if performed at 60 min
▪ Performed by first aspirating the stomach and then
repetitively instilling & aspirating fluid
▪ Left lateral position better - delays spont. absorption
▪ No evidence that larger tube better
▪ Simplest, quickest & least expensive way
▪ Choice of fluid is tap water - 5-10 ml/kg
69. Gastric lavage
▪ Preferrably done on awake patients
▪ Presence of an ET tube does not preclude
aspiration, though preferred if GCS is low
▪ No human studies in OP poisoning showing
benefit of gastric lavage
70. Single dose activated charcoal
0.5-1 gm/kg, adolescents 50-100 grams PO;
maximum dose 100 grams
More benefit if administered within 1 hour of
ingestion, but still good for poison which slows
gastric motility (anticholinergic, opiates,
salicylates)
Strongly consider for acetaminophen overdose >
4 hours
71. P – Pesticides, petroleum distillates,
unprotected airway
H – Hydrocarbons, heavy metals, > 1h delay
in administration
A – Acids, alkali, alcohol, altered level of
consciousness, aspiration risk
I – Iron, ileus, intestinal obstruction
L – Lithium, lack of gag reflex
S – seizures
72. Nonabsorbable, isotonic polyethylene glycol
Toxins “pushed” through GI tract; prevents
absorption
Concentration gradient created by this
allows absorbed toxin to diffuse back into GI
tract
Used where toxins NOT absorbed by
charcoal
77. Plasmapheresis
Works very well with highly protein (albumin)
bound drugs
Not a routine methodology, but has been used
to remove theophylline and digoxin/ digibind
complexes
Exchange transfusion
Use in smaller infants where vascular access for
extracorporeal techniques can’t be done
81. Iron Desferroxamine
Copper Penicillamine, Dimercaprol, CaEDTA
Lead CaEDTA, Dimercaprol (BAL)
Mercury DMPS, DMSA, BAL
Arsenic BAL & derivatives
Antimony BAL & derivatives
82. Calcium channel blockers: bradycardia and
hypotension; 1 - 10 mg tablet of nifedipine
Camphor: respiratory depression and seizures; 15
mL of Vicks vapo-rub (700 mg of camphor)
Clonidine: severe bradycardia; 0.1 mg
Tricyclic antidepressants: cardiovascular and CNS
toxicity; 10-20mg/kg
Opioids: CNS and respiratory depression; 2.5 mg of
hydrocodone.
83. Lomotil: anticholinergic overdose (tachycardia,
seizures, coma); ½ tablet
Salicylates: cerebral edema, acidosis, coma; ½
teaspoon of wintergreen fatal
Sulfonylureas: severe hypoglycemia; 1 tablet
Toxic alcohols: cardiac and CNS depression; 2.9mL
of 95% ethylene glycol has been fatal
84. National Poisons Information Centre (NPIC)
Department of Pharmacology
All India Institute of Medical Sciences
New Delhi, India
Tel. No.: 26589391, 26593677,
Fax: 26850691, 26862663
Email: npicaiims@hotmail.com
provides round-the-clock, 7 days-a-week, 365
days service on telephone.
85. Poisoning a common problem in our country
A high index of suspicion required to diagnose
Know common toxidrome & antidotes
Charcoal is only given if likely to benefit
Patients receiving decontamination must have airway protection
Don’t panic and follow a plan of action
Decreasing absorption
Enhancing elimination
Neutralising toxins
Avoid potentially harmful Rxs - risk vs benefit
Editor's Notes
Assessment triangle: -general appearance (sleepy, obtunded, wired, delirious,etc.) -work of breathing (too fast, too slow, too deep, too shallow) -circulation (hypertensive, hypotensive) Most toxic exposures can be treated with basic life support measures Oxygen, dextrose, and naloxone: diagnostic and therapeutic Toxidrome: constellation of symptoms which are most likely to indicate the ingestion of a certain class of medication. H&P plus lab eval.
Altered mental status: rule out other causes as clinically indicated: trauma (including abuse), infection, metabolic abnormality (DKA), etc.
Paracelsus = German physician, father of modern pharmacology