This document discusses bronchiolitis, which is the most common lower respiratory tract infection in infants under 2 years of age. It is usually caused by viral infections like respiratory syncytial virus. The symptoms include wheezing, difficulty breathing, coughing, and nasal congestion. Treatment is supportive and involves fluids, nasal suctioning, oxygen supplementation, and in severe cases, mechanical ventilation. Preventive measures include palivizumab injections for high-risk infants to reduce hospitalizations from RSV infection.
A short class presentation I gave in college detailing some opportunistic pathogens which attempt infection in HIV along with commonly used drugs for treatment.
References available in slides.
A short class presentation I gave in college detailing some opportunistic pathogens which attempt infection in HIV along with commonly used drugs for treatment.
References available in slides.
Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI SurgeryDr Pradeep Jain Reviews
Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI Surgery. Dr. Pradeep Jain Fortis Hospital has over 20 years of experience in the Laparoscopic GI and GI Oncology Surgery.
Fever, common cold and cough in pediatric age groups are common. Acute bronchiolitis is a diagnostic term used to describe the clinical picture produced by several different lower respiratory tract infections in infants and very young children (younger than 1yr ,some clinicians extend it to the age of 2 yr). Pneumonia defined as inflammation of lung parenchyma.
It is the leading infectious cause of death globally among children younger than 5 yr.
The introduction of antibiotics and vaccine against measles , pertussis ,haemophilus influenzae type b and PCV vaccine reduces the pneumonia related mortality over past 15 yr.
Newly Approved Agents: Lefamulin, the first systemic pleuromutilin antibiotic, was approved by the FDA in August 2019 (after the societies’ approval of the guidelines) for the treatment of adults with CAP caused by S pneumoniae, methicillin-susceptible S aureus (MSSA), H influenzae, Legionella pneumophila, M pneumoniae, and C pneumoniae.11,12 Lefamulin acts as a bacterial protein synthesis inhibitor by targeting the peptidyl transferase center of the 50S bacterial ribosomal subunit. It may be given either IV or orally at a dosage of 150 mg IV every 12 hours or 600 mg orally every 12 hours, with dosage adjustment required for patients with hepatic impairment. Lefamulin may prolong the QT interval, and its use should be avoided in patients who have known QT prolongation or are taking other QT-prolonging agents. Lefamulin has several other drug interactions. Its use should be avoided (because of potential for reduced efficacy) with strong or moderate CYP3A inducers or P-glycoprotein (Pgp) inducers. The oral formulation of lefamulin should not be used with agents that are that are strong CYP3A inhibitors or Pgp inhibitors or with CYP3A4 substrates that prolong the QT interval. Lefamulin may cause fetal harm, and females should be counseled to use effective contraception during treatment and for 2 days after completion of therapy.11-13
Delafloxacin, a fluoroquinolone antibiotic, was approved in October 2019 (after the guidelines were published) for treatment of adults with CAP caused by S pneumoniae, MSSA, selected gram-negative pathogens (Klebsiella pneumoniae, Escherichia coli, P aeruginosa, H influenzae, Haemophilus parainfluenzae), and atypical microorganisms (C pneumoniae, L pneumophila, M pneumoniae).14 It may be given either IV or orally at a dosage of 300 mg IV every 12 hours or 450 mg orally every 12 hours, with adjustment required for patients with severe renal impairment. Delafloxacin has the same warnings and precautions as other agents in the fluoroquinolone antimicrobial class.14,15
Directed Treatment
The patient’s clinical response should be evaluated after initiation of antimicrobial therapy. In cases where blood and/or sputum cultures are recommended, once microbiology culture and sensitivity results are available, antibiotic coverage should be deescalated and therapy should be directed at the pathogen(s) causing disease.4,9
Duration of Therapy
The recommended duration of antibiotic therapy has not changed from previously published guidelines. Patients with CAP should be treated for a minimum of 5 days, with antibiotic therapy continued until the patient achieves clinical stability. Validated measures of clinical stability include resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature); ability to eat; and normal mental status. Given that most patients achieve clinical stability within 48 to 72 hours after therapy initiation, a 5-day course typically is sufficient
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
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
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 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
2.
Acute inflammation, edema and necrosis of
epithelial cells lining small airways, increased
mucus production, and bronchospasm (AAP
2006)
First episode of wheezing in a child < 12-24
months with physical findings of a viral
respiratory infection and has no other
explanation for the wheezing, such as
pneumonia or atopy
www.dnbpediatrics.com
4.
Viral infection
◦
◦
◦
◦
◦
◦
◦
Respiratory syncytial virus (RSV)- MC (50-80%)
Rhinovirus – 2nd mc
Parainfluenza viruses
Influenza virus
Adenovirus
Coronavirus
Newer respiratory viruses - human metapneumovirus (hMPV),
human bocavirus (HBoV)
www.dnbpediatrics.com
5. Viral inoculation
viral replication in the epithelial cells of the
airway
Cell lysis
Necrotic cells slough off and release inflammatory
mediators
Airway inflammation and edema
Increased mucus production
Narrowing and obstruction of the bronchioles
Increased resistance to air flow, decreased
ventilation and air trapping
www.dnbpediatrics.com
6.
Most common lower respiratory tract
infection in infants
Age - < 2 years, peak incidence btw 2-6 months
Winter months
In India - September to March
www.dnbpediatrics.com
8.
Self-limited disease
Symptoms may persist for several weeks
In previously healthy infants - the average length of
hospitalization is 3 - 4 days
Prolonged course –
◦ Younger infants
◦ Comorbid conditions (e.g., chronic lung disease)
www.dnbpediatrics.com
10.
Diagnosis - clinical
Based on history and physical examination
Laboratory tests and CXR – not required, do
not alter treatment decisions
CXR
◦ If the diagnosis is in doubt
◦ co-morbidity like chronic lung disease or heart disease is
suspected
◦ there is no improvement
◦ child severely ill
www.dnbpediatrics.com
13.
Not routinely indicated
Abnormalities in TLC and DLC do not predict serious
bacterial infection in infants and young children
hospitalized with lower respiratory tract infection due
to RSV
Measurement of lactate dehydrogenase (LDH)
concentration in the nasal-wash fluid
◦ proposed as an objective indicator of bronchiolitis severity
◦ increased values (suggestive of a robust antiviral response)
have been shown to be associated with decreased risk of
hospitalization
◦ Needs further validation
www.dnbpediatrics.com
14.
Identification of viral agents does not affect
management
In the hospital setting, determining the responsible
virus may help to avoid unnecessary antibiotic use
Available tools - Antigen detection,
Immunofluorescence, PCR, and culture of respiratory
secretions obtained by nasal wash or nasal aspirate.
New techniques - real-time polymerase chain
reaction(PCR), nested PCR, and multiplex PCR
PCR – most sensitive
www.dnbpediatrics.com
15.
SUPPORTIVE CARE
Mainstay of treatment
(A) FLUIDS :–
Increased risk of dehydration because of their increased
needs (related to fever and tachypnea) and reduced oral
acceptance
Intravenous fluids
Children who can tolerate enteral feedings - small frequent
feedings or orogastric or nasogastric feedings
Children with bronchiolitis are also at an increased risk of
fluid retention (and subsequent pulmonary congestion)
www.dnbpediatrics.com
16. (B) NASAL DECONGESTION
Saline nose drops and cleaning of nostrils by gentle
suction
(C) RESPIRATORY SUPPORT
Supplemental oxygen
CPAP ----------- inconclusive evidence
Mechanical ventilation - clinical deterioration
(worsening respiratory distress, listlessness, and poor
peripheral perfusion), apnea/ bradycardia/ hypercarbia
www.dnbpediatrics.com
17. BRONCHODILATORS
Routine use of bronchodilators in the
management of bronchiolitis is debatable
Consider a trial of bronchodilator with careful
monitoring.
Salbutamol inhalation (personal or family
history of atopy or asthma)
Epinephrine inhalation
Further doses of either medications continued
only on documentation of improvement
www.dnbpediatrics.com
18. HYPERTONIC SALINE
Aerosolized hypertonic saline - therapeutic
modality for acute bronchiolitis.
Acts by
◦ Decreasing epithelial edema
◦ improving elasticity and viscosity of mucus
◦ improving airway clearance
Unanswered questions - optimal volume,
frequency of administration and effective
device
www.dnbpediatrics.com
19.
SYSTEMIC CORTICOSTEROIDS
◦ No significant differences found in hospital admission rate, length of
stay, clinical score after 12 hours, or hospital readmission rate
◦ Hence, it is recommended not to use glucocorticoids
CORTICOSTEROIDS + EPINEPHRINE
◦ Possible synergy
◦ Reduction in hospital admissions
◦ Still under evaluation
INHALED CORTICOSTEROIDS
◦ No evidence for use
www.dnbpediatrics.com
20. 1.
2.
3.
4.
CPAP
Surfactant - In severe bronchiolitis there may
be secondary surfactant insufficiency
suggesting possible role of administration of
exogenous surfactant
Current evidence - potential use in acute
severe bronchiolitis requiring mechanical
ventilation
Heliox
Aerosolized Ribavirin
www.dnbpediatrics.com
21.
-
-
-
Aerosolized Ribavirin
synthetic nucleoside analogue
acts by inhibiting viral protein synthesis
delivered as a small-particle aerosol for 18
to 20 hours per day
in high risk infants (immunocompromised
and/or hemodynamically significant
cardiopulmonary disease) and
in infants requiring mechanical ventilation
www.dnbpediatrics.com
23. General measures
Barrier nursing measures to prevent
nosocomial infections
Specific measures - Immunoprophylaxis
Polyclonal antibodies
Monoclonal antibodies
www.dnbpediatrics.com
24.
Contain RSV IgG
Prepared from pooled plasma
I/V route
Before RSV season
Disadvantages –
◦ need for I/V access;
◦ risk of transmission of blood-borne infections,
◦ possible interference with antibody response to
routine immunization specifically live vaccines
www.dnbpediatrics.com
25.
Produced by recombinant DNA technology
Targets the fusion protein of RSV, inhibiting
its entry into the cell and thereby preventing
infection
Reduces hospitalization rate in high risk
infants but does not reduce mortality rates
Expensive
www.dnbpediatrics.com
26.
I/M
Dose - 15 mg/kg monthly during the RSV season
Maximum of 5 doses is generally sufficient
prophylaxis during one season
Once a child qualifies for prophylaxis,
administration should continue throughout the
RSV season and not stop at the point he or she
reaches any certain age.
Adv –
◦ Can be given with routine immunizations since it does
not interfere with the immunologic response to vaccines
◦ Minimal S/E
www.dnbpediatrics.com
27. Infants Eligible for a
Maximum of 5 Doses
Infants Eligible for a
Maximum of 3 Doses
•Infants younger than 24
months of age with chronic lung
disease and requiring medical
therapy
•Infants younger than 24
months of age and requiring
medical therapy for congenital
heart disease
•Preterm infants born at 31
weeks, 6 days of gestation or
less
•Certain infants with
neuromuscular disease or
congenital abnormalities of the
airways
•Preterm infants with
gestational age of 32 weeks, 0
days to 34 weeks, 6 days with
at least 1 risk factor and born 3
months before or during RSV
season.
www.dnbpediatrics.com