This case presentation discusses a 24-year-old female patient admitted with complaints of fever, altered sensorium, headache, and body pains. Examination found increased white blood cell count in cerebrospinal fluid analysis consistent with viral meningitis. The patient was treated with acyclovir and other supportive medications and showed improvement over time. The document then reviews causes, presentation, diagnostic testing, and treatment approaches for viral and bacterial meningitis.
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
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it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
Case presentation on SLE with Pleural effusion (Soap format)Dr. Sharad Chand
Case presentation on SLE with Pleural effusion ,with typical SOAP format, Pharmaceutical care plan, pharmacist intervention & Critical appraisal of the laboratory datas compared with standard reference values.
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
thank u
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
Case presentation on SLE with Pleural effusion (Soap format)Dr. Sharad Chand
Case presentation on SLE with Pleural effusion ,with typical SOAP format, Pharmaceutical care plan, pharmacist intervention & Critical appraisal of the laboratory datas compared with standard reference values.
A case presentation of Tuberculous Meningitis. Management Included. This patient had experienced Drug-induced Hepatitis because of prescription reading error
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#CNS INFECTIONS
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
1. Case presentation on viral meningitis
Presented by :
METI.BHARATH KUMAR
16DK1T0014
Pharm-D(Intern)
2. Demographics
• Name :xyz
• Age :24YRS
• Sex:female
• Admission No:944
• Department : general medicine
unit :FM-7
• Date of admission :6/1/22
• Consultant physician:Dr Maheswara Reddy
3. Subjective evidence
• A 24yrs old female patient admitted in female
medical unit with complaints of
-fever since 10days
-altered sensorium
-fever associated with chills and rigors
-headache and body pains associated with
vomitings
4. Objective evidence
• CT and MRI normal study
• CBP : increased WBC count
• CSF analysis : glucose :54mg/dl
proteins:136mg/dl
cells: 130cells (90% lymhocytes)
5. Assesment
• Based on subjective and objective evidences
current condition is diagnosed as viral
meningitis
6. Planning
vitals
• Temp : febrile
• PR: 110bpm
• RR: 18/min
• SPO2 98% at RA
• BP:100/50 mmhg
• RBS: 96mg/dl
• Cvs : s1s2+
• RS : b/l AE +
• CNS:plantar b/l extension
treatment
• Inj taxim 2g iv bd
• Inj artesunate 120mg iv
• Inj clindamycin 300mg od
• Cap doxcycline bd
• Inj acyclovir 500mg iv tid
• Inj mannitol 100li iv tid
• Tab pct 500mg po tid
7. Drug chart
s.n
o
generic bran
d
indication Dose ROA frequ
ency
acyclovir To reduce vral infection 500mg po tid
2 artesunate To reduce malaria 120mg Iv Od
3 cefotaxim taxi
m
To reduce infection 2g Iv Bd
4 clindamycin To reduce fungal infection 300mg iv Od
5 doxycycline To reduce bacterial infection 200mg Po Bd
6 Pantoprazole pant
op
To reduce gi irritatio 40mg Iv Od
7 B complex Vitamin supplement 500mg po Od
Patient is kept on inj acyclovir 500mg iv tid . Pt improved
symptomatically from day 2 , advice to continue for next 14
days
8. discussion
• Meningitis is an inflammation (swelling) of the
protective membranes covering the brain and
spinal cord. A bacterial or viral infection of the
fluid surrounding the brain and spinal cord
usually causes the swelling.
• Pathophysiology. The brain is protected by the
skull and the pia, arachnoid, and dural meninges
as well as the blood–brain barrier. When any of
these defenses are breached by a microbial
pathogen an infl ammatory response within the
CSF occurs
9. • Classification and Risk Factors. Most commonly classified
based on the infecting pathogen and location at the onset
of illness.
• 1. Community-acquired meningitis. Patients have not been
recently hospitalized and/or undergone any recent
procedures (e.g., CSF shunt). Predisposing factors include
preexisting diabetes mellitus, otitis media, sinusitis,
pneumonia, and alcohol abuse. Pathogens can include
bacterial, viral, fungal, or parasitic agents.
• 2. Nosocomial meningitis and ventriculitis. Most commonly
related to infections associated with CSF shunts, CSF drains,
intrathecal drug therapy, deep brain stimulation hardware,
neurosurgery procedures, and head trauma. Also usually
associated with a typical nosocomial bacterial pathogen
(e.g., methicillin-resistant Staphylococcus aureus [MRSA] or
vancomycin-resistant Enterococcus spp)
10. CAUSES OF MENINGITIS
• A. Bacterial.
Predisposing factors depend on age, comorbid status, immune state,
and/or alcoholism.
• 1. Streptococcus pneumoniae. Most common cause of both
community and nosocomial infections despite the patient age or
immune status.
• 2. Haemophilus influenzae type B. Vaccination efforts have declined
rates in children.
• 3. Neisseria meningitidis (serogroups A, B, C, W135, and Y). Most
common pathogen in healthy young adults.Serogroup Y is
predominant in the United States and the second most common in
parts of Europe. Serogroup B is the most common strain across
Europe. Serogroup A has been responsible for large outbreaks in
the meningitis belt of Africa.
11. • 4. Listeria monocytogenes. Most commonly occurs in
infants and patients over the age of 50 years with cell-
mediated immune deficits and/or alcoholism.
• 5. Streptococcus pyogenes (group A beta-hemolytic
streptococci). Usually secondary to otitis media.
• 6. Streptococcus agalactiae (group B beta-hemolytic
streptococci). Most often occurs in poorly controlled
diabetic patients with an associated infection who are
greater than 65 years of age.
• 7. Staphylococcus (S. aureus or coagulase-negative
staphylococcus). Most frequently occur in the setting of
neurosurgical procedures or placement of CSF shunts.
12. • 8. Gram-negative bacilli (Pseudomonas or enteric
pathogens). Have been associated with
nosocomial meningitis in patients over the age of
50.
• 9. Mycobacterium tuberculosis (MTB). Usually
occurs in the setting of extrapulmonary
disseminated disease (see Chapter 14,
Tuberculosis, for more information).
• 10. Spirochetes. Treponema pallidum (secondary
syphilis) and Borrelia burgdorferi (Lyme disease)
13. • B. Viral.
Most commonly affect children but can occur at any age.
• 1. Enteroviruses (e.g., Coxsackie A and B, echovirus, poliovirus, and
enterovirus 71). Account for the majority of viral meningitis cases
with a fecal–oral transmission during late summer and autumn in
temperate climates (occurs year-round in the tropics).
• 2. Herpes simplex virus (HSV-1, HSV-2). HSV-2 accounts for the
majority of cases in association with primary genital herpes. In
immunocompetent patients, pure HSV meningitis is a self-limiting
condition, whereas HSV meningitis in immunocompromised hosts
or HSV encephalitis is a life-threatening medical emergency
requiring treatment.
• 3. Varicella-zoster virus (VZV). Almost always associated with
reactivation (e.g., shingles) rather than primary infection (e.g.,
chickenpox).
• 4. HIV. Most often occurs in the setting of acute infection (e.g.,
acute retroviral syndrome—lymphadenopathy, dermatitis,
pharyngitis, and oral candidiasis).
14. • 5. Measles–mumps–rubella (MMR) viruses. Rates have
declined with vaccination efforts, but the most
common cause in unvaccinated patients would involve
mumps (more common in males with or without
parotid gland swelling).
• 6. Arthropod-borne viruses and West Nile virus. Most
commonly associated with meningoencephalitis (see
Chapter 33, Infectious Encephalitis).
• 7. Lymphocytic choriomeningitis virus and Hantavirus.
These are rare causes associated with contact by
infected rodents.
15. C. Fungal. Pathogens most commonly occur in nosocomial
infections or immunocompromised patients such as
transplantation of stem cells or solid organs and with
HIV/AIDS (i.e., CD4 cell count below 200 cells/mm³).
While Candida and Aspergillus species are common,
other pathogens include:
1. Cryptococcus neoformans
2. Histoplasma capsulatum
3. Coccidioides immitis
D. Parasitic. Rare cause of community-acquired meningitis,
but the freshwater amoeba Naegleria fowleri can cause
primary amebic meningoencephalitis. Amoeba gain
access to the meninges and brain through disruption of
the cribriform plate and olfactory nerve and are nearly
always fatal.
16. CLINICAL PRESENTATION OF
MENINGITIS.
While the clinical presentation of meningitis may vary in children and
older adults, the classic triad is: acute onset fever, neck stiffness,
and altered mental status.
• A. Fever. Present in the majority of patients but may be absent in
older adults or immunocompromised.
• B. Neck Stiffness. Occurs in the majority of patients and most
commonly associated with headache.
• C. Altered Mental Status. Is typically defi ned as a Glasgow coma
score of less than 12 or a change in the patient’s baseline mental
status (e.g., dementia)
• D. Headache. Occurs in response to meningeal infl ammation. E.
Photophobia. Reduced tolerance to bright light presumed to be due
to meningeal infl ammation of the trigeminal nerve (ophthalmic
branch of cranial nerve 5). More commonly occurs with viral
meningitis. F. Nausea and Vomiting
17. CSF analysis
• Normal CSF values are: glucose 45 to 80
mg/dL with a bloodto-CSF glucose ratio
greater than or equal to 0.6; protein 15 to 45
mg/dL; and white blood cell (WBC) count less
than 5/mcL. CSF values should be obtained as
soon as possible following LP, as delays can
alter the cell count and glucose (falsely low
values).
19. Treatment
As it is diffi cult to differentiate bacterial from viral or fungal meningitis on
clinical grounds alone, patients often are placed on empirical antimicrobial
therapy based on the most likely pathogen that should be initiated as soon as
the diagnosis is considered.
20.
21. Viral Meningitis
1. HSV a. Immunocompetent host. Usually due to
HSV-2 with primary genital herpes. Thus, the
treatment is directed to genital herpes. b.
Immunocompromised host. Usually treatment is
with acyclovir 10 mg/kg IV q8 (adjusted for renal
failure) for 14 to 21 days.
2. 2. VZV. Usual treatment is the same as for
shingles with acyclovir 10 mg/kg IV q8 for 7 to
10 days or valacyclovir 1 g PO q8 for 7 to 10
days.