Croup is a respiratory illness that mainly affects young children, characterized by a barking cough and stridor. It is usually caused by viruses like parainfluenza or RSV infecting the larynx and trachea, causing inflammation and swelling that narrows the airway. Symptoms range from mild cough to severe distress. Treatment involves corticosteroids, nebulized epinephrine, humidified air, and hospitalization for children with progressive symptoms or respiratory distress. Croup has an excellent prognosis with near complete recovery in most cases.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
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.
Acute epiglottitis is an acute inflammatory condition of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula.It is a life-threatening infection that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.Bacterial etiology is the most common cause of epiglottitis. Soft tissue lateral xray of neck shows thumb sign. Airway management is the main concern of epiglottitis.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
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.
Acute epiglottitis is an acute inflammatory condition of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula.It is a life-threatening infection that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.Bacterial etiology is the most common cause of epiglottitis. Soft tissue lateral xray of neck shows thumb sign. Airway management is the main concern of epiglottitis.
Approach to Acute infective upper airway obstruction (infective stridor) in ...Jwan AlSofi
This lecture will discuss Approach to Acute infective upper airway obstruction (infective stridor) in children and paediatric age group.
Topics:-
Stridor
Stridor
croup,
Epiglottitis
laryngitis,
bacterial tracheitis
Retropharyngeal abscess
Spasmodic Croup
Acute laryngotracheobronchitis, commonly known as croup, is a respiratory condition that primarily affects infants and young children. It is characterized by inflammation of the larynx (voice box), trachea (windpipe), and bronchi (large airways in the lungs). Croup is often caused by viral infections, with parainfluenza virus being a common culprit
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
Child Healthcare: Lower respiratory tract conditionsSaide OER Africa
Child Healthcare addresses all the common and important clinical problems in children, including:immunisation history and examination growth and nutrition acute and chronic infections parasites skin conditions difficulties in the home and society.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
2. CROUPoCroup is a respiratory illness characterized by inspiratory
stridor, cough, and hoarseness.
oThese symptoms result from inflammation in the larynx and
subglottic airway
o A barking cough is the hallmark of croup among infants and
young children, whereas hoarseness predominates in older
children and adults.
o Although croup usually is a mild and self-limited illness,
significant upper airway obstruction, respiratory distress,
and rarely death, can occur.
3. The term croup has been
used to describe a variety
of upper respiratory
conditions in children
including :
o Laryngitis
o Laryngotracheitis
o Laryngotracheobronchitis
o bacterial tracheitis
o or spasmodic croup
4. Laryngitis:refers to inflammation limited to the larynx and manifests
itself as hoarseness . It usually occurs in older children and
adults
Laryngotracheitis:
refers to inflammation of the larynx and trachea .Although
lower airway signs are absent, the typical barking cough
will be present.
5. LARYNGOTRACHEO
BRONCHITIS (LTB):o occurs when inflammation extends into the bronchi,
resulting in lower airway signs
o Further extension of inflammation into the lower
airways results in laryngotracheobronchopneumonitis,
which sometimes can be complicated by bacterial
superinfection.
o Bacterial superinfection can be manifest as
pneumonia, bronchopneumonia, or bacterial tracheitis
6. Bacterial tracheitis:
o Bacterial tracheitis (also called bacterial croup) describes
bacterial infection of the subglottic trachea, resulting in a
thick, purulent exudate, which causes symptoms of upper
airway obstruction
o Bacterial tracheitis may occur as a complication of viral
respiratory infections (usually those which manifest
themselves as LTB or (laryngotracheobronchopneumonitis)
or as a primary bacterial infection.
7. SPASMODIC CROUP:
o Spasmodic croup is characterized by the sudden onset of
inspiratory stridor at night, short duration (several hours),
and sudden cessation.
o This is often in the setting of a mild upper respiratory
infection, but without fever or inflammation.
o A striking feature of spasmodic croup is its recurrent nature,
hence the alternate descriptive term, "frequently recurrent
croup". Because of some clinical overlap with atopic
diseases, it is sometimes referred to as "allergic croup".
10. Croup is usually caused by viruses. Bacterial infection
may occur secondarily.
o para influenza virus type 1,2 & 3
o Respiratory syncytial virus (RSV) and adenoviruses
o Human coronavirus NL63 (HCoV-NL63)
o Measles
o Influenza virus
o Rhinoviruses, enteroviruses (especially Coxsackie types
A9, B4,and B5, and echovirus types 4, 11, and 21),
o Herpes simplex virus
o Metapneumo viruses
11. Croup also may be caused by bacteria.
The most common secondary bacterial pathogens include
o Staphylococcus aureus
o Streptococcus pyogenes
o Streptococcus Pneumoniae
secondary bacterial infection may occur in children
with laryngotracheitis, laryngotracheobronchitis, or
laryngotracheobronchopneumonitis.
Bacterial infection:
12. EPIDOMIOLOGYo Croup affects about 15% of children
o most commonly occurs in children 6 to 36 months of age.
o It is more common in boys, with a male: female ratio of about
4:1
o Most cases occur in the fall or early winter
o Family history of croup is a risk factor for croup and recurrent
croup
14. o The viral pathogen is inhaled and infects the cells of the respiratory
epithelium. Consequently leading to localized inflammatory response
including
o Inflammation of the subglottic area
o Mucosal edema
o Increased mucous production
o Swelling of the involved airway particularly involving the lateral walls
of the trachea just below the vocal cords
o The combination of swelling, edema and excess mucous production
leads to narrowing of the internal airway lumen- this is aggravated by
inspiration where further inflammation can results from walls of the
subglottic space are drawn in during inspiration
17. o Over the next 12 to 48 hours, a progressively worsening "barky"
cough, hoarseness and inspiratory stridor are noted, secondary to
some degree of upper airway obstruction and laryngeal
inflammation.
o Croup symptoms appear to subside during the day (possibly
because of positioning), only to recur the following night.
o The onset is often rapid and typically in the early morning hours (e.g.,
2:00 am).
o Thus, a child with significant stridor presenting during
daylight, may be more seriously affected.
18. Most children with mild symptoms have no more than a croupy
cough and hoarse cry and some may have stridor only upon
activity or agitation.
Children with more severe cases have:
oinspiratory and expiratory stridor at rest.
ovisible suprasternal, intercostal, subcostal retractions.
oAir entry may be poor.
olethargy and agitation
ohypoxemia and increasing hypercarbia
orespiratory arrest may occur suddenly during an episode of
severe coughing
19. WARNING SIGNS:
o tachypnea, tachycardia out of
proportion to fever.
o hypotonia.
o unable to maintain adequate oral
intake.
o cyanosis.
20. DIAGNOSISo Laboratory studies add little to the diagnosis of croup if
bacterial infection is not suspected.
o White blood cell counts may be
elevated above 10,000 with a
predominance of polymorphonuclear
cells.
o White blood cell counts greater than
20,000 may suggest bacterial
superinfection
21. IMAGING:
o Lateral neck radiographs are often obtained, not as
much to confirm the diagnosis of croup, but to rule
out other causes of stridor such as soft tissue
densities in the trachea, a retropharyngeal abscess
and epiglottitis.
o Chest radiographs may show subglottic narrowing
(in 50% of children with croup), but this can also
be seen in normal patients.
22. PULSE OXIMETRYTo determine the percentage
of oxyhemoglobin in blood
pulsating through a network of
capillaries. A low reading of
oxygen saturation on pulse
oximetry indicates significant
respiratory impairment.
23. Direct or indirect laryngoscopy is not
usually required and is indicated if
there is a concern for an anatomical
malformation of the upper airway,
possible aspiration of a foreign object,
or should the child rapidly deteriorate
or not respond to routine therapy in
the anticipated manner.
Laryngoscopy
25. o Westley croup
score of <3.
o occasional
barking
cough, no
stridor at rest,
and mild or
absent
suprasternal
or subcostal
retractions.
o Is defined by a
Westley croup
score of 3 to 6.
o includes frequent
cough, audible
stridor at rest, and
visible retractions,
but little distress
or agitation.
o Is defined by a Westley croup
score of ≥8.
o consists of frequent cough,
prominent inspiratory (and,
occasionally, expiratory) stridor,
conspicuous retractions,
decreased air entry on
auscultation, and significant
distress and agitation. Lethargy,
cyanosis, and decreasing
retractions are harbingers of
impending respiratory failure.
Mild croup Medium
croup
Severe croup
26. DIFFERENTIAL DIAGNOSIS
o Acute epiglottitis
o Peritonsillar and
retropharyngeal
abscesses
o Foreign body
aspiration or Ingestion
o Allergic reaction
o Acute angioneurotic
Edema
o Upper airway injury
o Congenital
anomalies of the
upper airway
o Laryngeal
diphtheria
27. TREATMENT
oKeep child calm
oCool mist or night air
oSteam(vaporizer of from shower)
oAntipyretics
oEncouragement of fluid intake
oHumidified air
oSingle dose of oral dexamethasone(0.6 mg/kg)
MILD CROUP
28. MODERATE TO SEVERE CROUP
Supportive care
o Humidified air or humidified oxygen
o Monitoring
o Fluids
o Intubation
29. PHARMACOTHERAPY
oCorticosteroids provide benefit for children with
viral croup by reducing the severity and shortening
the course of the symptoms
o Dexamethasone is the most commonly used, with
the dose being 0.6 mg/kg (maximum 10 mg) by mouth
or intramuscularly
o Clinical improvement from corticosteroids is usually
not apparent until 6 hours after treatment.
30. NEBULIZED EPINEPHRINE
o Is thought to stimulate alpha-adrenergic receptors
with subsequent constriction of arterioles and
decreased laryngeal edema.
o Nebulized epinephrine may have marked effect to
decrease inspiratory stridor and the work of breathing.
o The effects of this medication last less than two hours
and children need to be monitored serially for the
return of symptoms.
31. RACEMIC EPINEPHRINE
L-epinephrine
o Is administered as 0.5 mL/kg per dose (maximum of 5 mL)
of a 1:1000 dilution. It is given via nebulizer over 15
minutes.
o Racemic epinephrine and L-epinephrine appear to be
equally effective.
o Is administered as 0.05 mL/kg per dose (maximum of 0.5
mL)of a 2.25 percent solution diluted to 3 mL total volume with
normal saline.
o It is given via nebulizer over 15 minutes.
32. Antibiotics should be used only to treat
specific bacterial complications of croup.
Hospitalization if :
o Progressive stridor
o Stridor at rest
o Respiratory distress
o Cyanosis
o Depressed mental status
33. o Viral croup is usually a self-limited disease
o The prognosis for croup is excellent, and recovery is
almost always complete.
o Symptoms usually improve within three days, but may
last for up to seven days
o Less than 5 percent of children with croup require
hospital admission, and among those, 1 to 6 percent
require intubation Mortality is rare, occurring in <0.5
percent of intubated children
PROGNOSIS
34. COMPLICATIONS
o hypoxemia (oxygen saturation
<92 percent in room air) and
respiratory failure.
o pulmonary edema
o pneumothorax, and
pneumomediastinum
complications in croup are rare.
o Lymphadenitis
o otitis media
o Secondary bacterial
infections
o Bacterial tracheitis
o bronchopneumonia,
and pneumonia
o cardiac arrest and
death
35. REFERENCES:o Nelson textbook of pediatrics 19th edition
o http://www.uptodate.com
o http://www.medescape.com
o http://www.hawaii.edu/medicine/pediatrics
o https://www.slideshare.net/najah_abbas/croup-laryngotracheobronchitis-
2015?qid=8e93eeb1-531b-4638-93de-
e00cf0f49367&v=&b=&from_search=6
o https://www.slideshare.net/mrmodaq/croup-55390752
o https://www.webmd.com/children/understanding-croup-basic-information
o http://www.mayoclinic.org/diseases-conditions/croup/symptoms-
causes/syc-20350348