This document provides information on community acquired pneumonia (CAP) in children. It discusses the definition, epidemiology, etiology, pathogenesis, clinical presentation, risk factors, severity assessment, investigations, treatment and management of CAP in various pediatric age groups. Pneumonia is a leading cause of death in children under 5 years old worldwide. Clinical features may include cough, fever, difficulty breathing and vary depending on the child's age. Diagnosis is based on clinical signs and chest x-ray findings. Treatment involves hospitalization for severe cases and oral antibiotics for non-severe cases.
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Pneumonia is an infection of the lungs. The air sacs in the lungs (called alveoli) fill up with pus and other fluid, which makes it hard for oxygen to reach the bloodstream.
Someone with pneumonia may have a fever, cough, or trouble breathing.
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Pneumonia is an infection of the lungs. The air sacs in the lungs (called alveoli) fill up with pus and other fluid, which makes it hard for oxygen to reach the bloodstream.
Someone with pneumonia may have a fever, cough, or trouble breathing.
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
This is a case study on Viral Pneumonia where a patient came with fever, generalised bodyache and fatigue but was undiagnosed , but when she suddenly, developed respiratory distress, desaturated,then the whole story got changed.so, may this study be of some help to you all!
Fever, common cold and cough in pediatric age groups are common. Acute bronchiolitis is a diagnostic term used to describe the clinical picture produced by several different lower respiratory tract infections in infants and very young children (younger than 1yr ,some clinicians extend it to the age of 2 yr). Pneumonia defined as inflammation of lung parenchyma.
It is the leading infectious cause of death globally among children younger than 5 yr.
The introduction of antibiotics and vaccine against measles , pertussis ,haemophilus influenzae type b and PCV vaccine reduces the pneumonia related mortality over past 15 yr.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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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
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.
2. Introduction
Pneumonia is the leading killer of children, causing
an estimated 1.9 million deaths worldwide under
the age of 5 years.
Pneumonia is an inflammation of the parenchyma
of the lungs.
In developed countries, the diagnosis is usually
made on the basis of radiographic findings.
The WHO has defined pneumonia solely on the
basis of clinical findings obtained by visual
inspection and counting the respiratory rate, for
developing countries.
4. Pathogenesis
The lower respiratory tract is normally kept sterile by
physiologic defense mechanisms, including
mucociliary clearance, the properties of normal
secretions such as secretory immunoglobulin A
(IgA), and clearing of the airway by coughing.
Immunologic defense mechanisms of the lung that
limit invasion by pathogenic organisms include
macrophages that are present in alveoli and
bronchioles, secretory IgA, and other
immunoglobulins.
5. Viral pneumonia usually results from spread of
infection along the airways, accompanied by direct
injury of the respiratory epithelium, which results in
airway obstruction from swelling, abnormal
secretions, and cellular debris.
M. pneumoniae attaches to the respiratory
epithelium, inhibits ciliary action, and leads to cellular
destruction and an inflammatory response in the
submucosa.
6. S. pneumoniae produces local edema that aids in
the proliferation of organisms and their spread into
adjacent portions of lung, often resulting in the
characteristic focal lobar involvement.
S. aureus pneumonia manifests in confluent
bronchopneumonia, which is often unilateral and
characterized by the presence of extensive areas of
hemorrhagic necrosis and irregular areas of
cavitation of the lung parenchyma, resulting in
pneumatoceles, empyema, or, at
times, bronchopulmonary fistulas.
7. Clinical presentation
Any patient presenting with cough and difficult or
rapid breathing should be considered as a case of
pneumonia.
8. Neonates
Neonates present with tachypnea, and signs of
respiratory distress such as grunting, flaring and
retractions.
Fever and cough may be absent; however
hypothermia and temperature instability may be
observed.
Nonspecific complaints, such as irritability or poor
feeding may be the presenting symptoms
Cyanosis may be present in severe cases
Chlamydia trachomatis pneumonia should be
considered in infants aged 2–4 wks and is often
associated with conjunctivitis.
9. Infants
After the first month of life, cough is the most common
presenting symptom.
Infants may have a history of antecedent upper
respiratory symptoms.
Depending upon the degree of illness, tachypnea,
grunting, and retractions may be noted.
Vomiting, poor feeding, and irritability are also common.
Infants with bacterial pneumonia often are febrile, but
those with viral or atypical pneumonia may have
lowgrade fever or could be afebrile.
Wheezing or noisy breathing. Wheeze suggests a viral
cause.
10. Toddlers and Preschool Children
A history of antecedent upper respiratory illness is
common.
Cough is the most common presenting symptom.
The presence and degree of fever is dependent
upon the organism involved.
Vomiting, particularly post-tussive, may be present.
Chest pain may be observed with inflammation of or
near the pleura.
Abdominal pain or tenderness is often seen in
children with lower lobe pneumonia.
11. Older Children and Adolescents
Atypical organisms, such as Mycoplasma are
common in this age group.
In addition to the symptoms observed in younger
children, adolescents may have other constitutional
symptoms, such as headache, pleuritic chest
pain, and vague abdominal pain.
Headache, fever and myalgia are associated with M.
pneumoniae.
Vomiting, diarrhea, pharyngitis, and otalgia/otitis are
also common symptoms.
12. Assess for Contributing Etiology
Contact with person(s) having respiratory infection
Possibility of foreign body aspiration
Possibility of primary aspiration
Stools consistent with malabsorption (may suggest cystic
fibrosis)
Sinusitis
Asthma
Growth and nutritional status
Dysmorphic syndromes
Neuromuscular weakness
Cardiac failure
13. Risk Factors of CAP
Malnourished state,
young age (<6 months),
post-measles state,
absence of (or inadequate) breastfeeding,
solid fuel use.
Hospital acquired infection/pneumonia include
hospitalization for ≥48 h, broad spectrum antibiotic
therapy for ≥7 days in the preceding 30
days, immunosuppressive therapy including
glucocorticoid therapy, neutropenia and severe
structural lung disease.
14. Severity Assessment
Any infant with age ≤2 months with symptoms
suggestive of pneumonia should be considered as
having severe pneumonia. Such a child needs
immediate hospitalization
Tachypnea (respiratory rate >60/min) in this age
group is often associated with hypoxemia.
15.
16. There is no validated criteria for severity assessment
in children >5 years.
In this age group, pneumonia is considered severe if
the following features (of severe respiratory distress)
are present.
o Respiratory rate >30/min
o Chest wall retraction
o Use of accessory muscles of respiration
o Altered sensorium
18. CXR:
Chest radiographs are not needed routinely in all children with
suspected pneumonia.
Specific indications include:
1. When the diagnosis is in doubt (bronchiolitis, asthma, developmental
malformation, foreign body inhalation, aspiration pneumonia etc.)
2. Asymmetrical findings on chest examination
3. Suspected complications of pneumonia (pleural
effusion, empyema, lung abscess etc.)
4. Known case of recurrent chest infection (asthma,cystic
fibrosis, immunodeficiency etc.)
5. Severe and very severe pneumonia
Findings to be looked for in chest radiograph include:
Parenchymal infiltrates (evidence of consolidation)
Features of atypical pneumonia (bilateral streaky infiltrate)
Presence of pneumatocele
Any evidence of foreign body inhalation
Pleural spaces for pneumothorax, effusion
19. Arterial blood gas (ABG):
The indications are:
1. Severe and very severe pneumonia
2. Hypoxemia on pulse oxymetry (SpO2 <94% on 40%
oxygen), cyanosis
3. Shock
20. Other Investigations in Hospitalized
Patients
Hemogram with total and differential leukocyte count
Serum electrolytes and renal function test
Blood culture: These are positive in 10%–20% of children with
pneumonia
Other diagnostic investigations:
In atypical pneumonia: Serology—
RSV, Mycoplasma, Chlamydia
CMV serology (if suspected like immune-compromised and
TORCH group of infection)
Atypical H1N1 (swine flu) testing during epidemics
CSF (if feasible) in case of
i. Newborns
ii. Infants presenting with altered sensorium
iii. Seizures
21. The indications for hospitalization are:
Age <2 months
Severe and very severe pneumonia (as per WHO
definition)
Signs of shock
Hypoxemia (requirement for supplemental oxygen)
Moderate to severe malnutrition because it increases the
risk of mortality
Recurrent chest infection (cardiopulmonary
disease, anatomical defects in airway, neurological
disease)
Immunocompromised state
Not accepting orally, dehydration, vomiting
No response or increased severity (treatment failure) on
appropriate oral antibiotic therapy
Family unable to provide appropriate care at home.
22. Baseline Stabilization
A-B-C
Resuscitation if required as per the Pediatric Assessment Triangle and
Primary Assessment
O2 inhalation by nasal prongs, at flow rate 1–5 l/min (depending on age) if
child has lower chest wall indrawing or SpO2 ≤92%.
First dose of antibiotic as early as possible; preferably after obtaining a
sample for blood culture. However, administration of the first dose should not
be delayed for this.
Hydration (intravenous or nasogastric tube feed)
i. If child is accepting orally well—allow orally (ad libitum)
ii. If not accepting well orally (but feeding not contraindicated)—Nasogastric
or orogastric feed can be started
iii. Start 0.45 Saline in 5% dextrose as 2/3rd to 3/4th maintenance if there is
respiratory distress (where feed cannot be started) or underlying dehydration
or ongoing losses through vomiting etc.
Treatment of other emergent co-morbidities
i. Hypoglycemia
ii. Electrolyte imbalance
23. Antibiotic Treatment
The choice of first-line antibiotic therapy is guided by:
Age of the child
Severity of pneumonia
Associated clinical features suggesting specific etiology
e.g. pustules suggesting Staphylococcal infection
Immune-suppressed or immunocompromised state (such
as post-measles state)
Underlying chronic lung disease e.g. cystic fibrosis
Radiographic pointers towards a specific etiology
(necrotizing pneumonia, pneumatoceles suggest
Staphylococcal infection, parahilar streaky infiltrates are
more common in atypical pneumonia.)
Presence of complication such as
pneumothorax/empyema.
24. Treatment of Non-severe Pneumonia (at home)
Non-severe pneumonia can be treated at home with
oral antibiotics in most cases.
Amoxicillin (50 mg/Kg/day) in 2 divided doses for 3– 5
days
Advise to return immediately if the child develops lower
chest indrawing, is unable to drink/feed, is excessively
sleepy or sick looking.
Follow-up after 2 days
If the child has persistent raised respiratory rate but no
indication for admission, change to Amoxicillin-
clavulanic acid (80–90 mg/kg of amoxicillin) in 2
divided doses for 5 days or add Azithromycin 5 mg/kg
for 5 days if clinical and radiological features suggest
atypical pneumonia.
If lower chest indrawing or a general danger sign
appears, hospitalize urgently for treatment as severe /
very severe pneumonia
25. Treatment of Severe Pneumonia
Hospitalize, continue oxygen.
Injectable ampicillin (50 mg/kg/dose) IV 6 hourly.
Add Cloxacillin (100–200 mg/kg/day in 4 four divided
doses) if clinical features (presence of
pustules, postmeasles state, severe
malnutrition, empyema) and radiographic features
(pneumatoceles, necrotizing pneumonia) suggest
Staphylococcal infection.
Assess and monitor for oral intake/feeding, respiratory
rate, chest indrawing, and oxygenation (by pulse oximetry)
.
If at any time danger signs of very severe pneumonia
develop treat as very severe pneumonia
After 48 h—if improved: continue: on oral amoxicillin for 5
more days, if not improved in 48 h/deteriorated: treat as
29. Indications for PICU Transfer
At any stage, the following should be considered for
transfer to ICU:
Very severe pneumonia
Hypoxemia
Patients requiring intubation/ventilation
Presence of shocky failure