Bronchiectasis refers to the congenital/acquired irreversible airway dilation that involves the bronchi/bronchioles in either a focal or a diffuse manner.
It is a pulmonary disease related to chronic infections in the background of inability of respiratory mucosa to clear the infections and impaired ciliary function.
It is chronic disease with high morbidity and mortality
PATHOGENESIS OF BRONCHIECTASIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MED...Prof Dr Bashir Ahmed Dar
Dr Bashir Ahmed Dar associate professor medicine chinkipora sopore kashmir presently working in malaysia speaks about bronchiectasis.Bronchiectasis which is defined as the irreversible dilatation of the cartilage-containing airways bronchi or bronchioles.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
PATHOGENESIS OF BRONCHIECTASIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MED...Prof Dr Bashir Ahmed Dar
Dr Bashir Ahmed Dar associate professor medicine chinkipora sopore kashmir presently working in malaysia speaks about bronchiectasis.Bronchiectasis which is defined as the irreversible dilatation of the cartilage-containing airways bronchi or bronchioles.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
Lecture slides about bronchiectasis with contents including definition, causes, pathogenesis and pathology, and how to make diagnosis. Treatment for bronchiectasis is presented separately.
Bronchiectasis
A condition characterized by chronic permanent dilation & destruction of bronchi due to destructive changes in the elastic and muscular layers of bronchial walls.
The common thread in the pathogenesis of bronchiectasis consists of difficulty clearing secretions & recurrent infections with a “vicious circle” of infection and inflammation resulting in airway injury and remodelling.
PLEASE REFER TO REFERENCE TEXTBOOKS FOR CLARITY.
PNEUMONIA,
DEFINITION
Pneumonia is an infection of the pulmonary parenchyma.
To the pathologist, pneumonia is an infection of the alveoli ,distal airways, and interstitium of the lung that is manifested by increased weight of the lungs, replacement of normal lung’s sponginess by consolidation ,and alveoli filled with white blood cells ,red blood cells and fibrin .To the clinician, pneumonia is a constellation of symptoms and signs in combination with at least one opacity on CXR.
Epidemiology
Between 5 and 10 million cases of infectious pneumonia occur annually in the United States and result in more than 1 million hospitalizations.
Pneumonia is a leading cause of death worldwide, the sixth leading cause of death in the United States, and the most common lethal infectious disease.
Lecture slides about bronchiectasis with contents including definition, causes, pathogenesis and pathology, and how to make diagnosis. Treatment for bronchiectasis is presented separately.
Bronchiectasis
A condition characterized by chronic permanent dilation & destruction of bronchi due to destructive changes in the elastic and muscular layers of bronchial walls.
The common thread in the pathogenesis of bronchiectasis consists of difficulty clearing secretions & recurrent infections with a “vicious circle” of infection and inflammation resulting in airway injury and remodelling.
PLEASE REFER TO REFERENCE TEXTBOOKS FOR CLARITY.
PNEUMONIA,
DEFINITION
Pneumonia is an infection of the pulmonary parenchyma.
To the pathologist, pneumonia is an infection of the alveoli ,distal airways, and interstitium of the lung that is manifested by increased weight of the lungs, replacement of normal lung’s sponginess by consolidation ,and alveoli filled with white blood cells ,red blood cells and fibrin .To the clinician, pneumonia is a constellation of symptoms and signs in combination with at least one opacity on CXR.
Epidemiology
Between 5 and 10 million cases of infectious pneumonia occur annually in the United States and result in more than 1 million hospitalizations.
Pneumonia is a leading cause of death worldwide, the sixth leading cause of death in the United States, and the most common lethal infectious disease.
BRONCHIECTASIS approach and treatment by Dr.Amira TabidiAmira30013
Pulmonolgy ,it's a common respiratory air way disease with many radiogical features that's vital to learn about it so you can reach the diagnosis easily along with a solid clinical approach
Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung.[5] Symptoms typically include a chronic cough with mucus production.[3] Other symptoms include shortness of breath, coughing up blood, and chest pain.[2] Wheezing and nail clubbing may also occur.[2] Those with the disease often get frequent lung infections.[8]
Bronchiectasis may result from a number of infectious and acquired causes, including pneumonia, tuberculosis, immune system problems, as well as the genetic disorder cystic fibrosis.[11][3][12] Cystic fibrosis eventually results in severe bronchiectasis in nearly all cases.[13] The cause in 10–50% of those without cystic fibrosis is unknown.[3] The mechanism of disease is breakdown of the airways due to an excessive inflammatory response.[3] Involved airways (bronchi) become enlarged and thus less able to clear secretions.[3] These secretions increase the amount of bacteria in the lungs, resulting in airway blockage and further breakdown of the airways.[3] It is classified as an obstructive lung disease, along with chronic obstructive pulmonary disease and asthma.[14] The diagnosis is suspected based on symptoms and confirmed using computed tomography.[7] Cultures of the mucus produced may be useful to determine treatment in those who have acute worsening and at least once a year
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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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
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.
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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- 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
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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
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.
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
3. Introduction
• Bronchiectasis refers to the congenital/acquired irreversible
airway dilation that involves the bronchi/bronchioles in either
a focal or a diffuse manner and that classically has been
categorized as:
i. Cylindrical or Tubular (the most common form)
ii. Varicose, or cystic.
4. Epidemiology
• Varies greatly with the underlying etiology.
• E.g., in CF often develop significant clinical bronchiectasis in
late adolescence or early adulthood, although atypical
presentations of CF in adults in their 30-40’s are also possible.
In contrast, bronchiectasis resulting from MAC infection
classically affects nonsmoking women older than age 50 years.
• Incidence of bronchiectasis increases with age.
• F>M
• More in those with disadvantaged socio-economic status
5. Cont…
• Highly prevalent where TB is prevalent: associated extrinsic
compression of the airway by enlarged granulomatous lymph
node and/or from development of intrinsic obstruction as a
result of erosion of a calcified lymph node through the airway
wall (e.g., broncholithiasis)
• Increased incidence in those with malnutrition
6. Aetiology
• Bronchiectasis can arise from infectious or noninfectious
causes.
• Up to 25–50% of cases the causes can not be identified
(idiopathic)
• Clues to the underlying aetiology are often provided by the
pattern of lung involvement.
i. Focal bronchiectasis = in a localized area of the lung and
can be a consequence of obstruction of the airway—either
extrinsic (e.g., due to compression by adjacent
lymphadenopathy or parenchymal tumor mass) or intrinsic
(e.g., due to an airway tumor or aspirated foreign body, a
scarred/stenotic airway, or bronchial atresia from
congenital underdevelopment of the airway).
7. Cont…
ii. Diffuse bronchiectasis =widespread changes throughout
the lung and often arises from an underlying systemic or
infectious disease process and cigarette/tobacco smoking.
• More of Central airways involvement: allergic
bronchopulmonary aspergillosis (ABPA)which an immune-
mediated process, also cartilage deficiency due
tracheobronchomegaly (Mounier-Kuhn syndrome) and
Williams-Campbell syndrome.
8. Cont…
• More upper lung fields involvement: cystic fibrosis (CF) and
postradiation fibrosis.
• Lower lung fields involvement: chronic recurrent aspiration
(e.g., due to esophageal motility disorders like those in
scleroderma), end-stage fibrotic lung disease (e.g., traction
bronchiectasis from idiopathic pulmonary fibrosis), or
recurrent immunodeficiency-associated infections (e.g.,
hypogammaglobulinemia).
• Predominantly Midlung fields MAC infections dyskinetic/
immotile cilia syndrome = Kartagener’s syndrome.
9. Pathogenesis
• The most widely cited mechanism of infectious bronchiectasis
is the “vicious cycle hypothesis,” in which susceptibility to
infection and poor mucociliary clearance result in microbial
colonization of the bronchial tree.
• The ensuing host response, immune effector cells
(predominantly neutrophils), neutrophilic proteases (elastase),
reactive oxygen intermediates (eg, hydrogen peroxide
[H2O2]), and inflammatory cytokines, creates transmural
inflammation, mucosal edema, cratering, ulceration, and
neovascularization in the airway
10. Cont…
• Some organisms, such as Pseudomonas aeruginosa, exhibit a
particular propensity for colonizing damaged airways and
evading host defense mechanisms.
• Impaired mucociliary clearance can result from inherited
conditions such as CF or dyskinetic cilia syndrome, and it has
been proposed that a single severe infection (e.g., pneumonia
caused by Bordetella pertussis or Mycoplasma pneumoniae)
can result in significant airway damage and poor secretion
clearance.
11. Cont…
• The presence of the microbes incites continued chronic
inflammation, with consequent damage to the airway
wall, continued impairment of secretion and microbial
clearance, and ongoing propagation of the infectious-
inflammatory cycle.
• Moreover, it has been proposed that mediators released
directly from bacteria can interfere with mucociliary clearance
12. Cont…
• Classic studies of the pathology of bronchiectasis from the
1950s demonstrated significant small-airway wall
inflammation and largerairway wall destruction as well as
dilation, with loss of elastin, smooth muscle, and cartilage.
• It has been proposed that inflammatory cells in the small
airways release proteases and other mediators, such as
reactive oxygen species and proinflammatory cytokines, that
damage the larger-airway walls… chronic inflammation
destroy the elastin and cartilage which causes dilation and
weakening of the bronchial walls
13. Cont…
• Furthermore, the ongoing inflammatory process in the smaller
airways results in airflow obstruction.
• It is believed that antiproteases, such as α1 antitrypsin, play
an important role in neutralizing the damaging effects of
neutrophil elastase and in enhancing bacterial killing.
• In addition to emphysema, bronchiectasis has been observed
in patients with α1 antitrypsin deficiency.
14. Cont…
• Proposed mechanisms for noninfectious bronchiectasis
include immune-mediated reactions that damage the
bronchial wall (e.g., those associated with systemic
autoimmune conditions such as Sjögren’s syndrome and
rheumatoid arthritis).
• Traction bronchiectasis refers to dilated airways arising from
parenchymal distortion as a result of lung fibrosis (e.g.,
postradiation fibrosis or idiopathic pulmonary fibrosis).
15. Clinical features
• Most common clinical presentation = persistent productive
cough with ongoing production of thick, mucopurulent
tenacious sputum.
• Hemoptysis
• Dyspnoea
• Wheezing (bases of the lung)
• Chest pain
16. Physical findings
• Cachexia
• Crackles and wheezing on lung auscultation
• ??Clubbing of the digits = sometimes.
• Mild to moderate airflow obstruction is often detected on
pulmonary function tests, overlapping with that seen
at presentation with other conditions, such as COPD. Acute
exacerbations of bronchiectasis are usually characterized by
changes in the nature of sputum
17. Diagnosis
• Suggestive hx of persistent chronic cough and sputum
production
• Physical exam paying attention to the Respiratory system
exam
• Sputum for Gram stain, culture and sensitivity, AFB, GeneXpert
• Bronchoalveolar lavage (BAL) fluid sample
• FBP
• Spirometry: reduced or normal FVC, low FEV1 and low
FEV1/FVC ratio
• Imaging
i. CXR
ii. CT Chest
iii. Bronchoscopy
18. Radiology
• CXR: non specific however presence of “tram tracks” can be
seen
• Chest CT = more specific for bronchiectasis = imaging modality
of choice for confirming the diagnosis. CT findings include
airway
i. Dilation (detected as parallel “tram tracks” or as the
“signet-ring sign”
ii. lack of bronchial tapering
iii. Bronchial wall thickening in dilated airways, inspissated
secretions (e.g., the “tree-in-bud” pattern), or cysts
emanating from the bronchial wall (especially pronounced
in cystic bronchiectasis)
19.
20.
21. Rx
• Rx of infectious bronchiectasis is directed at the control of
active infection and improvements in secretion clearance and
bronchial hygiene so as to decrease the microbial load within
the airways and minimize the risk of repeated infections.
• Antibiotic therapy: targeting the causative or presumptive
pathogen (with H. influenzae and P. aeruginosa isolated
commonly) should be administered in acute exacerbations,
usually for a minimum of 7–10 days.
• MAC strains are the most common NTM pathogens, and the
recommended regimen of a macrolide combined with
rifampin and ethambutol.
22.
23. Bronchial hygiene
• Enhancing secretion clearance in bronchiectasis:
i. Hydration and mucolytic administration: mucolytic
dornase (DNase) is recommended routinely in CF-related
bronchiectasis but not in non-CF bronchiectasis due to lack
of efficacy and potential harm in the non-CF population
ii. Aerosolization of bronchodilators
iii. Hyperosmolar agents (e.g., hypertonic saline)
iv. Chest physiotherapy (e.g., postural drainage, traditional
mechanical chest percussion via hand clapping to the chest,
or use of devices such as an oscillatory positive expiratory
pressure flutter valve or a high-frequency chest wall
oscillation vest).
24. Anti-inflammatory therapy
• Has benefit in bronchiectasis and may improve dyspnea,
decreased need for inhaled β-agonists, and reduced sputum
production.
• Inhaled/Oral glucocorticoids.
• Do not significantly improve lung function or bronchiectasis
exacerbation rates have been observed
• ABPA: prolonged course of treatment with the oral antifungal
agent itraconazole and oral corticosteroids
25. Refractory cases
• Surgery can be considered, with resection of a focal area of
suppuration.
• In advanced cases, lung transplantation if the patient is a
candidate
26. Complications
• Recurrent respiratory infections
• Microbial resistance due to prolonged/repeated antibiotic use
• Toxicity from repeated antibiotics use
• Hemorrhage into bronchial tree resulting into hemoptysis
• Cor pulmonale
• Lung abscess
27. Bronchiectasis exacerbation
• Increased sputum over baseline, thicker sputum, low grade
fever, increased of shortness of breath and pleuritic chest
pain.
• Most of these patients will need to be admitted
• Most commonly due to acute bacterial infections
• Of concern is P. aeruginosa infection which can be lethal
28. Rx of exacerbation
• O2 therapy titrated to 90%
• Routine labs, sputum cultures for Pseudomonas, Mycoplasma
• Broad spectrum antibiotics: if CF, assume Pseudomonas
• Beta agonists bronchodilators
• Chest physiotherapy, Pulmonary toilet (can use
spirometry)/bronchial hygiene
• Expectorants can be given
29. Prognosis
• Outcomes of bronchiectasis vary widely with the underlying
etiology and may also be influenced by the frequency of
exacerbations and (in infectious cases) the specific pathogens
involved.
30. Prevention
• Vaccination of patients with chronic respiratory conditions
(e.g., influenza and pneumococcal vaccines)
• Reversal of an underlying immunodeficient state (e.g., by
administration of gamma globulin for immunoglobulin-
deficient patients)
• Smoking cessation.
• After resolution of an acute infection in patients with
recurrences (e.g., ≥3 episodes per year), the use of
suppressive antibiotics to minimize the microbial load and
reduce the frequency of exacerbations has been proposed,
although there is less consensus with regard to this approach
in non-CF-associated bronchiectasis than there is in patients
with CF-related bronchiectasis.
31. Cont…
• Possible suppressive treatments include
i. Administration of an oral antibiotic (e.g., ciprofloxacin) daily
for 1–2 weeks per month
ii. Use of a rotating schedule of oral antibiotics (to minimize
the risk of development of drug resistance)
iii. Administration of a macrolide antibiotic daily or three times
per week (with mechanisms of possible benefit related
to non-antimicrobial properties, such as anti-inflammatory
effects and reduction of gram-negative bacillary biofilms)
32. Cont…
iv. inhalation of aerosolized antibiotics [e.g., tobramycin
inhalation solution (TOBI)] by select patients on a rotating
schedule (e.g., 30 days on, 30 days off) with the goal of
decreasing the microbial load without encountering
the side effects of systemic drug administration
v. Intermittent administration of IV antibiotics (e.g., “clean-
outs”) for patients with more severe bronchiectasis and/or
resistant pathogens. In addition, ongoing, consistent
attention to bronchial hygiene can promote secretion
clearance and decrease the microbial load in the airways.