PLEOCYTOSIS
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PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
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1) Neonatal cholestasis is defined as conjugated hyperbilirubinemia in newborns caused by diminished bile flow. The document discusses the definition, epidemiology, etiologies, clinical presentation, investigations and management of neonatal cholestasis.
2) The causes of neonatal cholestasis include intrahepatic causes like infections, metabolic disorders, and extrahepatic causes like biliary atresia and choledochal cysts. The most common causes of cholestasis in the first month are biliary atresia and neonatal hepatitis.
3) Evaluation involves history, physical exam, initial lab tests and further tests depending on the findings. Imaging like ultrasound
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This document discusses neonatal cholestasis, defined as conjugated hyperbilirubinemia developing within the first 90 days of life. It outlines the differential diagnosis and evaluation of neonatal cholestasis, distinguishing between extrahepatic and intrahepatic etiologies. Key tests and management strategies are described for different conditions, including nutritional support, treatment of symptoms, and surgical or transplant options for certain etiologies like biliary atresia.
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Hematuria In Children
1. Hematuria, or blood in the urine, can have many causes including infections, diseases of the kidney or urinary tract, and systemic diseases.
2. Evaluation of hematuria involves urinalysis to identify the source and presence of red blood cells, as well as examining the patient's history and symptoms.
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Neonatal Cholestasis
1) Neonatal cholestasis is defined as conjugated hyperbilirubinemia in newborns caused by diminished bile flow. The document discusses the definition, epidemiology, etiologies, clinical presentation, investigations and management of neonatal cholestasis.
2) The causes of neonatal cholestasis include intrahepatic causes like infections, metabolic disorders, and extrahepatic causes like biliary atresia and choledochal cysts. The most common causes of cholestasis in the first month are biliary atresia and neonatal hepatitis.
3) Evaluation involves history, physical exam, initial lab tests and further tests depending on the findings. Imaging like ultrasound
Fanconi anemia
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Hereditary spherocytosis
Hereditary spherocytosis is an inherited condition related to RBC destruction. its diagnosis is require to differentiate immune hemolytic anemia and G-6-P-D deficiency anemia
Hematuria In Children
1. Hematuria, or blood in the urine, can have many causes including infections, diseases of the kidney or urinary tract, and systemic diseases.
2. Evaluation of hematuria involves urinalysis to identify the source and presence of red blood cells, as well as examining the patient's history and symptoms.
3. For isolated hematuria without an identifiable cause, patients should be monitored over time as the hematuria may resolve, new symptoms may emerge warranting further testing, or the hematuria may persist long-term requiring ongoing follow-up.
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leukemoid reaction and leukemia
1. The document discusses the differentiation between myeloid leukemoid reaction, chronic myeloid leukemia (CML), and chronic neutrophilic leukemia (CNL).
2. Key differences include peripheral smear findings, bone marrow aspirate/biopsy pictures, LAP scores, cytogenetics, and immunophenotyping results.
3. A leukemoid reaction is secondary to an underlying cause and shows features of that cause, while CML and CNL are myeloproliferative neoplasms with distinct clinical features, lab findings, and disease progression.
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Methemoglobinaemia
This document provides information on methemoglobinemia, including:
- Definition as an abnormal increase in methemoglobin levels in red blood cells above 1%
- Symptoms vary based on methemoglobin levels and include cyanosis, headaches, and loss of consciousness
- Causes include ingestion of drugs/toxins like local anesthetics, nitrates, sulfonamides, and certain antibiotics
- Workup involves blood tests to check for anemia and enzyme levels to identify potential hereditary causes
Acute myeloid leukemia
This document provides information on Acute Myeloid Leukemia (AML), including:
- AML is a stem cell disorder characterized by a block in differentiation of myeloid precursors.
- It has several predisposing factors such as Down syndrome and exposure to radiation or chemicals.
- Diagnosis involves evaluation of blood counts, identification of blasts in blood and bone marrow, immunophenotyping of blasts, and cytogenetic/molecular testing.
- Several classification systems exist including the French-American-British (FAB) system and the current World Health Organization (WHO) system.
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This document provides information about evaluating a neonate presenting with cholestatic jaundice. It discusses performing a history and physical exam to identify potential etiologies. Key lab investigations are outlined to establish cholestasis and severity of liver injury. Imaging studies like ultrasound and hepatobiliary scintigraphy can help differentiate between extrahepatic and intrahepatic causes. The document reviews various etiologies of neonatal cholestasis including biliary atresia, idiopathic neonatal hepatitis, choledochal cyst, galactosemia, and TPN-related cholestasis. Timely evaluation is important to diagnose treatable conditions and identify those requiring surgical intervention.
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A case of a 3 month old boy with jaundice and pale stool is presented. On examination, he was icteric with hepatomegaly but no other abnormalities. Laboratory tests found direct hyperbilirubinemia. The objectives of the discussion are to understand neonatal cholestasis, evaluate cases, understand the differential diagnosis, and discuss treatment options. Neonatal cholestasis is prolonged conjugated hyperbilirubinemia beyond the first 14 days of life. Causes include extrahepatic conditions like biliary atresia or intrahepatic conditions like idiopathic neonatal hepatitis. Evaluation and management aim to identify treatable causes and prevent progression of liver disease.
Anemia & polycythemia in neonates
This document summarizes anemia and polycythemia in newborns. It discusses physiologic anemia of infancy, anemia of prematurity, and the pathophysiology of hemorrhagic anemia, hemolytic anemia, and hypoplastic anemia. Clinical presentations are described based on the type of anemia. Diagnosis involves initial studies and other tests. Management includes transfusion, replacement of nutrients, and erythropoietin administration. Polycythemia is also covered, including causes, presentation, diagnosis involving central venous hematocrit, and management through observation or partial exchange transfusion for symptomatic infants.
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A 45-year-old male presented with a 2-month history of dry cough and 1-week history of shortness of breath. He was diagnosed with disseminated tuberculosis involving the lungs and massive pericardial effusion. He was started on anti-tuberculosis medications and steroids. He developed lower limb deep vein thrombosis and was started on anticoagulation. He underwent pericardial drainage and window procedure. His treatment plan includes continuing anti-TB medications, increasing warfarin dose, and educating the patient about medication adherence and side effect monitoring.
Idiopathic (autoimmune) Thrombocytopenic Purpura
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts and bruising. It most commonly affects children ages 1-4 years old within 4 weeks of a viral infection. An autoantibody develops against platelets, causing their destruction by the spleen. Most cases of childhood ITP are mild and resolve spontaneously within 6 months. Treatment involves observation for mild cases or corticosteroids, IVIG, or anti-D therapy for more severe cases. Splenectomy is reserved for chronic or uncontrolled cases.
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This document provides an overview on approaching and managing a child with jaundice. It begins by defining jaundice as a visible manifestation of increased bilirubin levels. It then discusses the burden of jaundice in newborns, describing how most will experience some jaundice in the first week due to immature bilirubin metabolism. The document outlines how to classify jaundice as physiological or pathological based on clinical signs and bilirubin levels. For pathological jaundice, the main treatment approaches of phototherapy and exchange transfusion are described. The document provides guidance on evaluating the potential causes of jaundice and managing cases based on whether the hyperbilirubinemia is conjugated or
Diagnosis of Anemia
This document provides information on the diagnosis of anemia. It defines anemia and outlines the grading and classification systems. It discusses the prevalence of anemia globally and in India. The clinical presentation and diagnostic workup are described. Guidelines are provided on evaluating different types of anemia based on red blood cell indices, including iron deficiency anemia, thalassemia, megaloblastic anemia, aplastic anemia, anemia of chronic disease, and hemolytic anemias. Diagnostic testing for specific conditions like sickle cell anemia and glucose-6-phosphate dehydrogenase deficiency is also reviewed.
Approach to neonatal jaundice
Approach to neonatal jaundice - Simplified
references : Cloherty And Stark's Manual Of Neonatal Care
AIIMS Protocol In Neonatology
Care Of The Newborn – Meherban Singh
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This document provides an overview of pancytopenia, including definitions, common causes, clinical evaluation, and diagnostic approach. Pancytopenia is defined as a reduction in all three blood cell lines. The evaluation involves obtaining a complete blood count with peripheral smear, bone marrow aspiration and biopsy, and specific tests depending on findings. The bone marrow examination can help differentiate causes based on cellularity and features seen in erythropoiesis, myelopoiesis, megakaryopoiesis and other cell types. Common causes include bone marrow failure, infiltrative disorders, infections, immune disorders and nutritional deficiencies. A thorough history, examination and systematic evaluation of the bone marrow are required to identify the underlying cause of pancy
Microcytic hypochromic anemia
1) Microcytic hypochromic anemia is characterized by small, pale red blood cells and can be caused by iron deficiency, thalassemia, sideroblastic anemia, or other conditions.
2) Iron deficiency anemia is the most common cause and results from inadequate iron intake or absorption. It disrupts hemoglobin synthesis and cellular proliferation.
3) Thalassemia is an inherited disorder of hemoglobin production that can range from mild to severe. Thalassemia major requires regular blood transfusions and causes severe anemia from ineffective erythropoiesis and hemolysis.
Interpretation of nerve biopsy
1. Nerve biopsy can help diagnose various types of neuropathies by examining the nerve for signs of axonal degeneration, demyelination, inflammation, and other abnormalities.
2. Specific pathological findings on biopsy can indicate conditions like vasculitis, sarcoidosis, infections, inflammatory demyelinating polyneuropathy, and amyloid or lymphomatous involvement of nerves.
3. Biopsy of the sural nerve is commonly performed as it is a distal sensory nerve that is easily accessible and removable without significant functional deficit. Processing and staining of biopsy samples can identify features diagnostic of different neuropathy etiologies.
Approach to hemolytic anemia
Dr Sarath Menon presents an approach to diagnosing and classifying hemolytic anemia. Hemolytic anemia results from increased red blood cell destruction and bone marrow compensation. It can be congenital/hereditary or acquired. Classification includes intracorpuscular defects like hemoglobinopathies and enzymopathies, and extracorpuscular factors like mechanical destruction, toxic agents, infections, and autoimmune causes. Diagnosis involves confirming hemolysis and determining the etiology through history, physical exam, peripheral smear, and ancillary lab tests. Common etiologies discussed in detail include sickle cell disease, thalassemia, G6PD deficiency, membrane defects like hereditary spherocytosis, and autoimmune
Sickle cell anemia
1. The patient presented with headache and right-sided hemiplegia, consistent with an acute stroke.
2. Strokes in sickle cell disease are most commonly ischemic and occur bimodally, peaking in younger children and those over 30 years old. Hemorrhagic strokes are rarer and peak during the second decade.
3. Diagnostic workup includes blood tests and neuroimaging to determine if the stroke is ischemic or hemorrhagic, as management differs between the two.
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Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
Pancytopenia
Pancytopenia is a condition defined by low levels of red blood cells, white blood cells, and platelets. It can be caused by bone marrow failure, bone marrow infiltration, ineffective hematopoiesis, or peripheral destruction/pooling of blood cells. Evaluating the history, examination, blood counts, blood film, bone marrow aspiration/biopsy, and other tests can help determine the underlying cause, such as aplastic anemia, leukemia, lymphoma, or myelodysplastic syndrome. The bone marrow may appear hypocellular, normocellular, or hypercellular, providing clues to diagnoses like aplastic anemia or hematologic malignancies.
Methemoglobinaemia
This document provides information on methemoglobinemia, including:
- Definition as an abnormal increase in methemoglobin levels in red blood cells above 1%
- Symptoms vary based on methemoglobin levels and include cyanosis, headaches, and loss of consciousness
- Causes include ingestion of drugs/toxins like local anesthetics, nitrates, sulfonamides, and certain antibiotics
- Workup involves blood tests to check for anemia and enzyme levels to identify potential hereditary causes
Acute myeloid leukemia
This document provides information on Acute Myeloid Leukemia (AML), including:
- AML is a stem cell disorder characterized by a block in differentiation of myeloid precursors.
- It has several predisposing factors such as Down syndrome and exposure to radiation or chemicals.
- Diagnosis involves evaluation of blood counts, identification of blasts in blood and bone marrow, immunophenotyping of blasts, and cytogenetic/molecular testing.
- Several classification systems exist including the French-American-British (FAB) system and the current World Health Organization (WHO) system.
Anemia of prematurity
ANEMIA OF PREMATURITY IS A PROBLEM WORTH KNOWING IN ANY MEDICAL PRACTITIONER INVOLVED IN THE CARE OF PREMATURE INFANTS.
Seminar on neonatal cholestasis
This document provides information about evaluating a neonate presenting with cholestatic jaundice. It discusses performing a history and physical exam to identify potential etiologies. Key lab investigations are outlined to establish cholestasis and severity of liver injury. Imaging studies like ultrasound and hepatobiliary scintigraphy can help differentiate between extrahepatic and intrahepatic causes. The document reviews various etiologies of neonatal cholestasis including biliary atresia, idiopathic neonatal hepatitis, choledochal cyst, galactosemia, and TPN-related cholestasis. Timely evaluation is important to diagnose treatable conditions and identify those requiring surgical intervention.
Hypoxic ischemic encephalopathy: Lecture on HIE
Clinically, more term babies suffered from hypoxic ischemic encephalopathy (HIE) than premature babies. However, pathologically, more premature babies suffered from HIE than term babies. The main clinical manifestations of HIE are symptoms of consciousness, including excitation symptoms like hyperalertness, irritability, and seizures, or depressing symptoms like coma and hypotonia. Management of HIE focuses on monitoring, controlling seizures, general supportive care, and recent advances like therapeutic hypothermia. The prognosis depends on the severity of brain damage and treatment, with mild or moderate cases often recovering completely but severe cases having a high risk of mortality or long-term complications.
Acute Lymphoblastic Leukemia
Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by increased numbers of immature lymphocytes in the bone marrow. It is the most common cancer in children. Treatment involves chemotherapy given systemically and intrathecally in phases including induction, consolidation and maintenance to achieve and maintain remission. Prognosis depends on risk factors like age, white blood cell count, genetics. Late effects of intensive chemotherapy include secondary cancers, organ dysfunction. Relapse indicates poor prognosis requiring aggressive salvage therapies like stem cell transplant.
Paroxysmal nocturnal hematuria
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematopoietic stem cell disorder characterized by hemolytic anemia. It arises due to a somatic mutation in the PIGA gene, causing deficiency of glycosylphosphatidylinositol-anchored proteins (GPI-APs) like CD55 and CD59 on the surface of blood cells. This renders the cells highly sensitive to complement-mediated lysis. Diagnosis involves flow cytometry to detect GPI-AP deficiency and tests like Ham and sucrose hemolysis to demonstrate complement sensitivity of the red blood cells. PNH is associated with hemoglobinuria, thrombosis, and bone marrow failure. It requires differentiation
Neonatal Cholestasis
A case of a 3 month old boy with jaundice and pale stool is presented. On examination, he was icteric with hepatomegaly but no other abnormalities. Laboratory tests found direct hyperbilirubinemia. The objectives of the discussion are to understand neonatal cholestasis, evaluate cases, understand the differential diagnosis, and discuss treatment options. Neonatal cholestasis is prolonged conjugated hyperbilirubinemia beyond the first 14 days of life. Causes include extrahepatic conditions like biliary atresia or intrahepatic conditions like idiopathic neonatal hepatitis. Evaluation and management aim to identify treatable causes and prevent progression of liver disease.
Anemia & polycythemia in neonates
This document summarizes anemia and polycythemia in newborns. It discusses physiologic anemia of infancy, anemia of prematurity, and the pathophysiology of hemorrhagic anemia, hemolytic anemia, and hypoplastic anemia. Clinical presentations are described based on the type of anemia. Diagnosis involves initial studies and other tests. Management includes transfusion, replacement of nutrients, and erythropoietin administration. Polycythemia is also covered, including causes, presentation, diagnosis involving central venous hematocrit, and management through observation or partial exchange transfusion for symptomatic infants.
disseminated TB
A 45-year-old male presented with a 2-month history of dry cough and 1-week history of shortness of breath. He was diagnosed with disseminated tuberculosis involving the lungs and massive pericardial effusion. He was started on anti-tuberculosis medications and steroids. He developed lower limb deep vein thrombosis and was started on anticoagulation. He underwent pericardial drainage and window procedure. His treatment plan includes continuing anti-TB medications, increasing warfarin dose, and educating the patient about medication adherence and side effect monitoring.
Idiopathic (autoimmune) Thrombocytopenic Purpura
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts and bruising. It most commonly affects children ages 1-4 years old within 4 weeks of a viral infection. An autoantibody develops against platelets, causing their destruction by the spleen. Most cases of childhood ITP are mild and resolve spontaneously within 6 months. Treatment involves observation for mild cases or corticosteroids, IVIG, or anti-D therapy for more severe cases. Splenectomy is reserved for chronic or uncontrolled cases.
Approach to a child with jaundice
This document provides an overview on approaching and managing a child with jaundice. It begins by defining jaundice as a visible manifestation of increased bilirubin levels. It then discusses the burden of jaundice in newborns, describing how most will experience some jaundice in the first week due to immature bilirubin metabolism. The document outlines how to classify jaundice as physiological or pathological based on clinical signs and bilirubin levels. For pathological jaundice, the main treatment approaches of phototherapy and exchange transfusion are described. The document provides guidance on evaluating the potential causes of jaundice and managing cases based on whether the hyperbilirubinemia is conjugated or
Diagnosis of Anemia
This document provides information on the diagnosis of anemia. It defines anemia and outlines the grading and classification systems. It discusses the prevalence of anemia globally and in India. The clinical presentation and diagnostic workup are described. Guidelines are provided on evaluating different types of anemia based on red blood cell indices, including iron deficiency anemia, thalassemia, megaloblastic anemia, aplastic anemia, anemia of chronic disease, and hemolytic anemias. Diagnostic testing for specific conditions like sickle cell anemia and glucose-6-phosphate dehydrogenase deficiency is also reviewed.
Approach to neonatal jaundice
Approach to neonatal jaundice - Simplified
references : Cloherty And Stark's Manual Of Neonatal Care
AIIMS Protocol In Neonatology
Care Of The Newborn – Meherban Singh
Approach to pancytopenia
This document provides an overview of pancytopenia, including definitions, common causes, clinical evaluation, and diagnostic approach. Pancytopenia is defined as a reduction in all three blood cell lines. The evaluation involves obtaining a complete blood count with peripheral smear, bone marrow aspiration and biopsy, and specific tests depending on findings. The bone marrow examination can help differentiate causes based on cellularity and features seen in erythropoiesis, myelopoiesis, megakaryopoiesis and other cell types. Common causes include bone marrow failure, infiltrative disorders, infections, immune disorders and nutritional deficiencies. A thorough history, examination and systematic evaluation of the bone marrow are required to identify the underlying cause of pancy
Microcytic hypochromic anemia
1) Microcytic hypochromic anemia is characterized by small, pale red blood cells and can be caused by iron deficiency, thalassemia, sideroblastic anemia, or other conditions.
2) Iron deficiency anemia is the most common cause and results from inadequate iron intake or absorption. It disrupts hemoglobin synthesis and cellular proliferation.
3) Thalassemia is an inherited disorder of hemoglobin production that can range from mild to severe. Thalassemia major requires regular blood transfusions and causes severe anemia from ineffective erythropoiesis and hemolysis.
Interpretation of nerve biopsy
1. Nerve biopsy can help diagnose various types of neuropathies by examining the nerve for signs of axonal degeneration, demyelination, inflammation, and other abnormalities.
2. Specific pathological findings on biopsy can indicate conditions like vasculitis, sarcoidosis, infections, inflammatory demyelinating polyneuropathy, and amyloid or lymphomatous involvement of nerves.
3. Biopsy of the sural nerve is commonly performed as it is a distal sensory nerve that is easily accessible and removable without significant functional deficit. Processing and staining of biopsy samples can identify features diagnostic of different neuropathy etiologies.
Approach to hemolytic anemia
Dr Sarath Menon presents an approach to diagnosing and classifying hemolytic anemia. Hemolytic anemia results from increased red blood cell destruction and bone marrow compensation. It can be congenital/hereditary or acquired. Classification includes intracorpuscular defects like hemoglobinopathies and enzymopathies, and extracorpuscular factors like mechanical destruction, toxic agents, infections, and autoimmune causes. Diagnosis involves confirming hemolysis and determining the etiology through history, physical exam, peripheral smear, and ancillary lab tests. Common etiologies discussed in detail include sickle cell disease, thalassemia, G6PD deficiency, membrane defects like hereditary spherocytosis, and autoimmune
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Sickle cell anemia
1. The patient presented with headache and right-sided hemiplegia, consistent with an acute stroke.
2. Strokes in sickle cell disease are most commonly ischemic and occur bimodally, peaking in younger children and those over 30 years old. Hemorrhagic strokes are rarer and peak during the second decade.
3. Diagnostic workup includes blood tests and neuroimaging to determine if the stroke is ischemic or hemorrhagic, as management differs between the two.
Ventriculitis.pptx
Ventriculitis is an inflammation of the ependymal lining of the cerebral ventricles that is usually secondary to infection from meningitis, devices, or trauma. It presents with non-specific symptoms like fever and headache. Diagnosis involves analysis of CSF showing elevated white blood cells and proteins with normal or low glucose. Management includes high dose intravenous antibiotics, removal of any devices, and monitoring of CSF parameters until infection clears. Outcomes are better when the infecting organism has low virulence and treatment includes both antibiotics and device removal.
Immune hydrops
Immune hydrops fetalis is a condition where excess fluid builds up in fetal tissues due to maternal antibodies destroying fetal red blood cells. It can be caused by Rh incompatibility between mother and fetus. The excess hemolysis of fetal red blood cells leads to anemia, liver and spleen damage, heart failure and fluid buildup. Ultrasound is used to diagnose hydrops fetalis by detecting fluid in two fetal compartments. Treatment involves monitoring the fetus and performing intrauterine blood transfusions if needed to improve fetal hemoglobin levels and resolve hydrops. Routine Rh immunoprophylaxis can prevent Rh sensitization and immune hydrops in subsequent pregnancies.
MYELOPROLIFERARIVE NEOPLASM-1.pptx
This document provides information on myeloproliferative neoplasms (MPNs), a group of bone marrow disorders characterized by the overproduction of blood cells. It describes the main MPNs - polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). PV causes excessive red blood cell production. ET results in unusually high platelet counts. PMF involves the replacement of healthy bone marrow with scar tissue. The document outlines diagnostic criteria and clinical features of each condition, caused by mutations that stimulate the abnormal proliferation of stem/progenitor cells. Transitional cases between MPNs can also occur, or transformation to acute leukemia.
Differential leukocyte count
The document provides information on differential leukocyte counting (DLC). It defines DLC as the relative proportion of different leukocytes expressed as a percentage. The main types of white blood cells (WBCs) described are granulocytes (neutrophils, eosinophils, basophils) and agranulocytes/mononuclear cells (lymphocytes, monocytes). Pathologic variations in DLC counts include neutrophilia, neutropenia, lymphocytosis, lymphopenia, monocytosis, eosinophilia, eosinopenia, and basophilia. Causes of each variation are outlined. Automated methods for differential counting are also discussed and compared to manual microscopic methods
Hyperviscosity syndrome
Hyperviscosity syndrome (HVS) occurs when increased levels of proteins, cells, or other components in the blood cause it to become abnormally viscous or thick. This leads to reduced blood flow and organ damage. HVS is diagnosed based on clinical signs and symptoms along with laboratory tests showing elevated blood viscosity. Treatment involves reducing the cause of viscosity, typically through plasmapheresis to remove excess proteins in multiple myeloma or Waldenstrom macroglobulinemia. Prompt treatment is needed to prevent organ damage and vision loss from HVS.
CSF EXAMINATION
The document provides information on cerebrospinal fluid (CSF) examination including indications, collection, analysis, and findings in different conditions like meningitis. It discusses three clinical cases. For case 1, the diagnosis is bacterial meningitis based on cloudy CSF, low glucose, and high neutrophil count. Further tests would include cultures and sensitivity. For case 2, the diagnosis is viral meningitis (measles) based on clear CSF, normal glucose, and lymphocytic pleocytosis; complications include encephalitis. For case 3, the diagnosis is tuberculous meningitis based on low glucose, low chloride, and lymphocytic pleocytosis; confirmation requires microbiological tests.
2. NEC.ppt
Necrotizing enterocolitis (NEC) is a leading cause of emergency surgery in neonates, most commonly affecting very low birthweight preterm infants. It involves inflammation and necrosis of the bowels. Risk factors include prematurity, enteral feedings, and circulatory instability. Clinically, infants may experience feeding intolerance and abdominal distension. Diagnosis involves abdominal x-rays showing signs like pneumatosis intestinalis or portal venous gas. Treatment involves stopping feeds, antibiotics, and possible surgery for severe or perforated cases. Long-term complications can include strictures and short bowel syndrome.
Necrotizing enterocolitis
This document provides an overview of necrotizing enterocolitis (NEC), including its epidemiology, risk factors, pathophysiology, clinical features, management, outcomes, prevention and areas for further research. Some key points:
- NEC most commonly affects very preterm infants, with a mortality rate around 13% that increases with lower birth weight.
- Risk factors include prematurity, hypoxia, poor intestinal integrity, bacterial colonization and enteral feeding.
- Clinically it presents with abdominal distension, bloody stools and vomiting. Diagnosis is confirmed via x-ray showing pneumatosis or free air.
- Management involves stopping feeds, antibiotics, surgery for complications like perforation.
Cogenital malformation for postbasic.pptx
This document discusses congenital malformations, specifically hydrocephalus and neural tube defects. It defines hydrocephalus as excessive cerebrospinal fluid in the brain ventricles caused by impaired fluid circulation or absorption. It describes the anatomy of cerebrospinal fluid circulation and the mechanisms of communicating and non-communicating hydrocephalus. It also discusses neural tube defects including spina bifida, anencephaly and encephalocele, their causes, risk factors, clinical presentation and diagnosis. The management of hydrocephalus and neural tube defects in newborns is also outlined.
Leukocytosis
Leukocyte is another name for white blood cell (WBC). These are the cells in your blood that help your body fight infections and some diseases.
When the number of white cells in your blood is higher than normal, it’s called leukocytosis. This usually happens because you’re sick, but sometimes it’s just a sign that your body is stressed.is a condition that affects all types of white blood cells. Other illnesses, such as neutrophilia, lymphocytosis, and granulocytosis, target specific types of white blood cells. Normal white blood cell counts are 4,300-10,800 white blood cells per microliter. Leukocyte or white blood cell levels are considered elevated when they are between 15,000-20,000 per microliter. The increased number of leukocytes can occur abnormally as a result of an infection.An abnormally large number of leukocytes, as observed in acute infections, inflammation, hemorrhage, and other conditions. A white blood cell count of 10,000/mm3 (or more) usually indicates leukocytosis Most examples of leukocytosis represent a disproportionate increase in the number of cells in the neutrophilic series, and the term is frequently used synonymously with the designation neutrophilia. Leukocytosis of 15,000-25,000/mm3 is frequently observed in various pathologic conditions, and values as high as 40,000 are not unusual; occasionally, as in some examples of leukemoid reactions, white blood cell counts may range up to 100,000/mm3.Leukocytosis is usually a response to an infection or inflammation, so it’s not a cause for alarm. However, it can be caused by serious diseases such as leukemia and other cancers, so it’s important that your doctor diagnose the cause of an increased WBC when it’s found. Leukocytosis associated with pregnancy or in response to exercise is normal and nothing to worry about.
Myeloproliferative Disorders Other Than CML
This document provides an overview of myeloproliferative diseases other than chronic myeloid leukemia. It defines myeloproliferative diseases as disorders characterized by proliferation of one or more hematologic cell lines. The document discusses classifications, clinical presentations, diagnostic criteria, genetic mutations, outcomes, and treatment options for several myeloproliferative diseases including polycythemia vera, essential thrombocythemia, and primary myelofibrosis.
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This document discusses hemolytic disease of the newborn (HDN), specifically Rh incompatibility. It defines HDN as a condition where a fetus or neonate's red blood cells are destroyed by IgG antibodies produced by the mother. The document then covers the history of HDN, causes including Rh and ABO incompatibility, the pathophysiology whereby the mother's antibodies cross the placenta and destroy the baby's red blood cells, clinical symptoms ranging from jaundice to hydrops fetalis, prenatal and postnatal testing, and treatments such as intrauterine transfusions to prevent complications like hydrops fetalis.
Aplast anemia.pptx
Aplastic anemia is a bone marrow failure syndrome characterized by pancytopenia and a hypocellular bone marrow. It can be caused by radiation, chemicals, drugs, infections, autoimmune or genetic conditions. Patients present with bleeding, anemia symptoms, or infection. Diagnosis involves blood tests showing pancytopenia and low reticulocytes, along with a bone marrow biopsy demonstrating a hypocellular marrow. Treatment involves stem cell transplant or immunosuppression with antithymocyte globulin and cyclosporine.
MENINGITIS IN CHILDREN-1.pptx by John wambugu clinical officer paediatrics
This document provides an overview of meningitis, including its definition, causes, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. Key points include:
- Meningitis is an inflammation of the meninges that surround the brain and spinal cord. It can be caused by bacterial, viral, or fungal infections.
- Bacterial meningitis requires urgent treatment with antibiotics as it can be fatal if untreated. Common bacterial causes include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b.
- Symptoms may include fever, headache, stiff neck, nausea, confusion, and seizures. Diagnosis involves examination of cerebrospinal fluid
Approach to bleeding neonate siddarth mahajan
This document discusses the approach to evaluating and treating bleeding in neonates. It notes that the neonatal coagulation system is different from adults, with lower levels of several coagulation factors at birth. A clinical approach is outlined, examining factors like the baby's health status and risk factors. Common causes of bleeding include coagulation defects, platelet issues, fibrinolytic dysfunction, and vascular abnormalities. Tests like complete blood count, coagulation studies, and peripheral smear can help identify the underlying cause. Treatment depends on the diagnosis but may include vitamin K, fresh frozen plasma, or specific coagulation factor replacements.
Approach to bleeding neonate
The document discusses the approach to evaluating and diagnosing bleeding in neonates. It notes that while the neonatal coagulation system is immature compared to adults, healthy term infants do not typically have bleeding issues. A bleeding neonate should first be assessed for general health and vitamin K administration history. Screening tests include a complete blood count, coagulation tests, and peripheral smear. Abnormal results can indicate disorders like disseminated intravascular coagulation, infection, liver disease, immune thrombocytopenia, or inherited coagulation factor deficiencies. The causes, patterns, and management of various bleeding disorders seen in neonates are described.
cerebro spinal fluid analysis
The document provides information on cerebrospinal fluid (CSF) analysis, including its production, circulation, and examination. It discusses normal CSF values and abnormalities seen in various conditions. The lumbar puncture procedure and complications are also outlined. Abnormalities in CSF parameters like increased white blood cells, decreased glucose, and elevated proteins can indicate infections like bacterial meningitis, while more subtle changes may be seen in viral meningitis and tuberculosis meningitis. CSF analysis is useful for diagnosis.
Pregnancy Induced Hypertension- Pathophysiology
This document discusses the pathophysiology of pregnancy induced hypertension. It begins by noting that hypertension is a leading cause of maternal and perinatal mortality, with an incidence of 5-10% that is increasing. It then describes the normal hemodynamic changes in pregnancy, including increased plasma volume and cardiac output. The document discusses etiologies such as poor placentation and immunological factors. It outlines the pathogenesis, including vasospasm, endothelial activation, and angiogenic/antiangiogenic factors. It details effects on organ systems like the brain, liver, kidneys and cardiovascular system. Finally, it provides classifications for HELLP syndrome and reviews its associated maternal morbidities.
Csf composition and significance by Dr. Ashok KUmar J
This document discusses cerebrospinal fluid (CSF) composition and analysis. It covers normal and abnormal CSF pressure, indications for CSF analysis, and methods for examining CSF samples. Key points include:
- Normal CSF pressure ranges from 70-150 mm H2O and increases with posture and decreases with conditions like dehydration.
- CSF analysis indicates conditions like meningitis, tumors, and demyelinating diseases. Samples are examined grossly and chemically.
- Abnormal CSF may appear cloudy, bloody, or xanthochromic. Increased protein levels indicate issues like meningitis or tumors. Specific proteins indicate diseases like Alzheimer's or Creutzfeldt-Jakob disease.
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Thalassemia
This document summarizes thalassemia, a hereditary blood disorder caused by reduced or absent production of hemoglobin A. It describes the main types (alpha and beta thalassemia), clinical features like anemia and jaundice, diagnostic testing, and management which includes lifelong blood transfusions and iron chelation therapy to prevent complications from iron overload. The most severe forms can be fatal without treatment while milder forms may cause few symptoms.
Soffacation (suicidal)
Suffocation is a general term used to indicate death due to lack of oxygen from either lack of oxygen in the breathable environment or obstruction of external air passages. Asphyxia is caused by lack of oxygen in respired air leading to hypoxaemia and hypercapnia. Smothering causes asphyxia through mechanical obstruction of the external airways (nose and mouth). Suicidal smothering often involves placing a plastic bag over the head in an attempt to cut off oxygen. Classic signs of asphyxia include petechial hemorrhages, cyanosis, congestion, and soft tissue swelling due to increased venous pressure and fluid leakage from blood vessels.
Road & railway injury (suicidal)
Road accidents typically cause gross musculoskeletal or organ damage, severe haemorrhaging, airway blockage from blood, or traumatic asphyxiation from chest crushing. Railway suicides often result in decapitation or extensive body disintegration from being struck by a fast-moving train. Toxicology screens should be performed to check for alcohol or drugs which may have contributed to suicidal behavior. Electrical injuries may also complicate cases where high-voltage train systems are involved.
Strangulation (Hanging)
Strangulation, hanging, suffocation, road/railway injuries, and electrocution are common methods of suicidal death. Strangulation causes asphyxia by compressing the neck and blocking blood flow and air passage to the brain. Hanging causes cerebral hypoxia by compressing the neck and jugular veins. Suffocation involves blocking external airways. Road/railway injuries typically cause severe trauma, hemorrhage or organ damage. Electrocution usually causes cardiac arrhythmias and ventricular fibrillation leading to cardiac arrest. Autopsies look for neck furrows, petechiae, internal injuries or electrical marks depending on the method.
Retinitis pigmentosa (opthalmology)
Retinitis pigmentosa is a slow degenerative, hereditary disease of the retina that involves the rods and cones. It typically appears as a recessive trait due to consanguinity of the parents. Patients experience night blindness in childhood, tunnel vision or central visual loss in middle age, and complete blindness in advanced age. Physical examination shows black spots resembling bone corpuscles across the retina, extremely attenuated retinal blood vessels, and pale optic discs, indicating optic nerve atrophy. There is no specific treatment currently available, but cataract surgery and rehabilitation services can help manage complications.
Refrective error (opthalmology)
This document discusses refractive errors of the eye, including emmetropia, myopia, and hypermetropia. Emmetropia is the normal optical condition where light focuses on the retina. Myopia, or near-sightedness, occurs when light focuses in front of the retina. Symptoms include indistinct distant vision. Hypermetropia, or far-sightedness, is when light focuses behind the retina, causing blurred near vision and eye strain. Both conditions are typically corrected with spectacles, while myopia can also be treated through surgical procedures like LASIK in some cases.
Gradual loss of vision (opthalmology)
This document provides guidance on evaluating patients presenting with gradual loss of vision. It outlines taking a history to determine factors like onset, progression, associated symptoms and medical history. The physical exam involves assessing visual acuity, the red reflex, visual fields and optic nerve/macula. Common causes of gradual vision loss include glaucoma, refractive error, cataract, diabetic retinopathy and age-related macular degeneration. Treatment depends on the underlying cause but may involve prescription lenses, medical management or referral for further evaluation.
Glaucoma (opthalmology)
Glaucoma is a group of eye conditions that damage the optic nerve, often caused by an increase in intraocular pressure. The aqueous humour maintains pressure in the eye and normally flows through the anterior chamber, draining out of the eye. In glaucoma, the drainage pathways become blocked, increasing pressure and damaging the optic nerve. There are several types of glaucoma including open-angle glaucoma, the most common type caused by slow drainage blockage, and closed-angle glaucoma caused by physical blockage of drainage canals. Treatment aims to lower pressure through eye drops or surgery and slow progression of vision loss.
Electrocution (suicidal)
ELECTROCUTION (suicidal)
- The most common cause of death from electrocution is cardiac arrhythmias leading to ventricular fibrillation and cardiac arrest. Less commonly, respiratory arrest can occur if the current passes through the thorax, causing spasms or paralysis of intercostal muscles and the diaphragm.
- External signs include an areola of blanched skin at the contact points and possible "crocodile skin" lesions from sparking over several centimeters if voltages were in the kilovolt range. Internal autopsy findings are often absent or non-specific since the most common mode of death is cardiac arrhythmia.
Diabetic retinopathy (opthalmology)
Diabetic retinopathy is a complication of diabetes mellitus where changes occur in the retina. It is a leading cause of vision loss among working age adults in Malaysia. The risk of retinopathy rises with longer duration of diabetes and poor blood glucose control. Annual eye screening is recommended to detect early signs and plan treatment. Laser photocoagulation is commonly used to treat early stages while vitrectomy may be used for advanced proliferative cases with vitreous hemorrhage. Anti-VEGF drugs combined with laser can also treat diabetic macular edema.
Cataract (opthalmology)
Cataracts are a clouding of the lens of the eye that can cause gradual vision loss. They are usually caused by aging but can be caused by other factors like diabetes, smoking, or UV exposure. Cataracts are diagnosed based on a decrease in the red reflex seen during eye exams. They can be treated surgically through phacoemulsification to remove the clouded lens and replace it with an intraocular lens, improving vision. Age-related macular degeneration (AMD) is a disease of the macula that causes central vision loss. Dry AMD involves drusen buildup while wet AMD has abnormal blood vessel growth. Treatments include vitamins for dry AMD and anti-VEGF injections or photod
Mechanism of swallowing
The document summarizes the three stages of swallowing (deglutition):
1) Buccal stage where the tongue retracts forcing the bolus into the oropharynx.
2) Pharyngeal stage is involuntary where the soft palate and larynx elevate to prevent food entering the nasal cavity and lungs. The bolus moves into the upper esophagus.
3) Esophageal stage where peristalsis propels the bolus through the esophagus and into the stomach over 8-20 seconds while the lower esophageal and stomach sphincters relax.
Lung cancer
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
Lung cancer
The document describes a case of a 26-year-old man presenting with facial swelling, lumps in his armpits, chest pain for 3 months, and weight loss over 6 months. Examination found nail clubbing and a chest X-ray showed abnormalities. Biopsy and scans confirmed stage IV lung cancer. Nail clubbing is associated with lung diseases and cancers and results from vascular changes and growth factors from the lungs. Different types of biopsies are used to diagnose cancers including needle, endoscopic, and surgical biopsies. The anatomy of the chest is also described including structures like the ribs, sternum, and thoracic skeleton that make up the rib cage.
ZOLLINGER-ELLISON SYNDROME
Mr. Lim, a 47-year-old man, presented with abdominal pain and diarrhea. Endoscopy revealed a duodenal ulcer and CT scan showed a 3cm pancreatic head mass suspected to be a gastrinoma. Laboratory tests found highly elevated gastrin and basal gastric acid levels consistent with Zollinger-Ellison Syndrome. Further tests demonstrated increased gastrin response to secretin stimulation, confirming a gastrin-secreting pancreatic tumor as the cause of his symptoms. Complications of ZES include peptic ulcers, diarrhea from excess acid inactivating pancreatic enzymes, and potential malignant spread of gastrinomas. Omeprazole was prescribed to reduce gastric acid levels and treat his
Acute Pancreatitis
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
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Hepatitis C virus
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TREATMENT OF ACUTE CRUCIATE LIGAMENT INJURY
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
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Circulatory shock
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
ANATOMY OF KNEE JOINT
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
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M.pharm - 1st year .Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
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Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort. Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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PLEOCYTOSIS
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- 2. Definition • Pleocytosis defined as an increased cell count , usually increase in white blood cell (wbc) count in cerebrospinal fluid (csf) • BUT, pleocytosis due to increased of csf protein and csf glucose also happen in some cases • Increased in wbc can be either elevated of polymorphonuclear leucocytes or mononuclear leucocytes
- 3. Increased of mononuclear cell due to virus Increased of polymorphonuclear cell due to bacteria Pleocytosis Polymorphonuclear cell Mononuclear cell
- 5. Increased WBC in the CSF • This happen when WBC count greater than 5/mmcubic • Giving clue to the clinicians it is due to invasion bacterias or viruses • This can be due to meningitis,encaphalitis
- 6. Abnormalities of CSF glucose • High traces of glucose in the CSF may be a reflection of higher blood glucose (hyperglycemia) • Lower levels of glucose in the CSF may indicate increased glucose use • Lower CSF glucose levels are often found in conjunction with infections of the central nervous system.
- 7. Abnormalities of CSF protein • It can be caused by increased permeability of the blood-brain barrier • High levels of protein in the CSF may indicate that blood is spilling into the CSF • Diseases in which there is increased CSF protein include hydrocephalus, meningitis, Guillain-Barre syndrome, subarachnoid hemorrhage
- 8. Conclusion • Result of a CSF examination are used to further narrow the diagnostic possibilities • The important clues include whether the clinical conditions is =acute/chronic =infectious/noninfectious =predominantly lymphocytic or neutrophilic