A 9-year-old boy presented with a 1-month history of fever, 15-day history of left-sided weakness, and 10-day history of seizures. On examination, he had increased tone, power, and reflexes on the left side. Investigations revealed moyamoya disease on MRI/MRA brain. Moyamoya disease is a condition of stenosis/occlusion of cerebral arteries, which can lead to ischemic strokes in children.
left ventricular hypertrophy, coarcatation of the aorta. contains case discussion, diagnosis, management, discussion, pathophysiology, treatment and labs.
left ventricular hypertrophy, coarcatation of the aorta. contains case discussion, diagnosis, management, discussion, pathophysiology, treatment and labs.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
3. case scenario
• 9 years old boy fazal u Rahman weighting 20kg, 2nd issue of
cosanguineous marriage, completely vaccinated and
developmentally up to date ,resident of miro khan admitted
in emergency department of peads unit-1 with the
• P C : Fever for 1 month
• Left side weakness for 15 days
• Fits for 10 Days
4. HOPC
• According to father his child was in usual state of heath one
month back then he developed Fever which was Gradual In
Onset ,Low Grade ,Intermittent in pattern, not documented , no
any special time of occurrence, not associated with ear
discharge , sore throat ,head ache, cough , burning micturition,
loose stools ,vomiting, constipation, pain in right flank ,rashes,
joint pain.
• my patient has also complain of left
sided weakness involving left lower limb first then upper limb,
gradual in onset , static in nature, associated with fits, first time
,tonic clonic in nature , 2 to 3 minutes duration ,4 to 5 times in a
day , associated with difficulty in speech but not associated
with unrolling of eyes ,urinary incontinence, unconsciousness,
,hearing, smelling , vision,swolling,difficulty in closing eyes,
protruding tongue, eating ,sitting and changing clothes .
5. • vomiting, loose stools ,polyuria ,polyphagia ,peri orbital
puffiness ,frothing of urine, jaundice or decrease in school
performance, rashes or marks on face or body, no hx of
trauma , early morning head ache, vomiting,hx of chicken
pox,cyanosis,chest pain during playing, repeated chest
infections, fever with joint pain,hx of repeated stroke
attacks, sever head ache,hx of pica ,swelling of fingers,
repeated transfusions, swelling of hands and legs , no
family history of DM ,HTN,Heart disease or increase
cholesterol ,n0 hx of death before 50 years of age with this
complain.
6. Continued……
After that they visited to a doctor he advsed brain
imaging in the form of CT scan brain and advised
medications in the form of syrups ,attendant don’t
know the names of syrups but each syrup 1tsf x bd
was advised by doctor ,the condition of patient was
static that’s why they move to tertiary care hospital.
7. Systemic Review
• Central nervous system :fits ,weakness , difficulty in
speech .
• GENRAL :Normal appetite, sleep is sound no weight
loss.
• Gastrointestinal system: no hx loose stools
,vomiting,constipation,abdominal pain .
• Genitourinary system : no hx burning micturition,pain in
flanks,poluria ,anuria .
• Chest system : no hx of cough ,chest pain, shortness of
breath .
• Cardiovascular system :no hx of chest pain ,cyanosis,
tachycardia,
• Locomotor system: no hx of jount pain, joint swelling
10. Nutritional history
• The total caloric requirement of my patient is
1500kcal/day but due to illness he is eating
1200kcal/day .
11. Family history
• Ther are total 7 family members
• 2nd issue product of consengenious marriage
• He has 4 other siblings all are healthy,
• No such hx is found in family
12. Socioeconomic history
• Belongs to poor socioeconomic status.
• Father is farmer by occupation
• Monthly income is 20000 to 30000 rupess.
• Mother is house wife
• Live in kaccha house
• Drink bore water
14. Case summary
9 years old boy fazal u Rahman weighting 20kg, 2nd issue of
consanguineous marriage, completely vaccinated and
developmentally up to date came with complain of fever for 1
month left side weakness for 15 days and fits for 10 days,
fever is low grade ,gradual in onset, not associated with
chills and riggors,intermitant in pattern,not documented,no
any special time of occurance,15 days back pt also
developed left sided weakness ,involving lower limb first then
upper limb,gradual in onset, static in nature my pt also
developed fits, fits were tonic clonic in nature, 4 to 5
episodes In a day ,2 to 3 mintues duration, fits were observed
first time not associated with uprolling of eye ,urinary
incontinence,unconsciousness .
16. GERNAL PHYSICAL EXAMINATION
• A school going boy lying of a bed with no obvious signs of respiratory distress
or dysmorphic facies NG passed ,cannulated in left hand with following vitals
• VITALS
• Blood Pressure:121/66 mm of Hg(lies below 50th percentile)
• Heart Rate 128beats /mint
• Respiratary Rate 17breaths/mint
• Tempersture Afebrile
19. ABDOMINAL EXAMINATION:
• Inspection: shape is normal moving with respiration
umbilicus is centrally placed no scar or visible
veins
• Palpation : soft non tender, no viseromeally, ,
bladder is not palpable , hernia orifices were intact.
• Percussion : percussion note was dull .
• Auscultation : Bowel sounds were audible .
20. RESPIRATORY EXAMINATION:
• Inspection: Shape of chest was normal ,type of breathing
abdomino-thorasic ,moving equally with respiration no any scar
mark visible veins .
• Palpation t ,no tenderness, crepitus,treachea was centrally
placed
Apex beat is located at 5th intercostal space medial to mid
clavicle line
• Percussion :upper border of liver was percussed at 6th intercostal
space, percussion note was resonant
• Auscultation : there was bronchial breathing and equal air entry
on both sides of chest, vocal resonance was normal,there was
no pleural rub.
.
21. CARDIOVASCULAR EXAMINATION:
• INSPECTION: Pericardium is normal shaped
without any scar visible pulsations seen
• PALPATION: Apex beat is located at 5th intercostal
space ½ Inch medial to mid clavicle line with
normal character
• AUSCULTATION: S1 S2 Audible with normal
intensity and no added sound or murmur heard
22. CNS EXAMINATION
GCS 12/15
SOMI - VE
CRANIAL NERVES: Intact
SPINE EXAMINATION: normal and bladder not palpable
MOTOR EXAMINATION:
RUL LUL RLL LLL
BULK Normal Normal Normal Normal
TONE Normal Normal increased increased
POWER 3/5 2/5 3/5 2/5
REFLEXES 2+ 2+ 3+ 3+
PLANTARS
CLONUS
Up going
Present
Up going
present
23. Case summary
• 9 years old boy fazal u Rahman weighting 20kg, 2nd issue of
consanguineous marriage, completely vaccinated and
developmentally up to date came with complain of fever for 1
month left side weakness for 15 days and fits for 10 days, fever
is low grade ,gradual in onset, not associated with chills and
riggors,intermitant in pattern, not documented, no any special
time of occurance,15 days back pt also developed left sided
weakness ,involving lower limb first then upper limb,gradual in
onset, static in nature my pt also developed fits, fits were tonic
clonic in nature, 4 to 5 episodes In a day ,2 to 3 mintues
duration, fits were observed first time not associated with
uprolling of eye ,urinary incontinence, unconsciousness ,on
examination he is vitally stable with signs of upper motor neuron
are appreciated in the form of increased tone ,power, deep
tendon reflexes with up going planters and clonus are present .
27. SERUM ELECTROLYTES AND
LIVER FUNCTION TEST:
Parameter Result Normal Range
SODIUM 138mg/dl
POTASSIUM 4.9mg/dl
CHLORIDE 100mg/dl 0
BI CARBONATE 25U/L
CALCIUM 9.6U/L
SGPT 26U/L <55
43. PEDIATRIC STOKE
• A Pediatric stroke can be classified by the type,age
at which occurred, and the vessels involved.
• The three primary types are arterial ischemic
stroke ,cerebral sinovenousthrombosis and
hemorrhagic stroke.
• Within literature pediatric stroke is also classified
by number of vessels and type of arterial territory
involved.
44. ARTERIAL ISCHEMIC STROKE
• In children arterial ischemic stroke is also comman sub
type,accounting for just over half of all stroke.
• Ischemic stroke is defined as sudden infarction of brain
tissue diagnosed by neuroimagingor at autopsy,and can
result in arterial ischemic strokeor venous infarction.
• An arterial ischemic stroke can occur when there is
sudden occlusion of one or more cereberal arteries.
45. • CEREBRAL SINOVENOUS THROMBOSIS Is
defined by thrombosis of superficial and deep venous
system.
•
• HAEMORRHAGIC STROKE
• Is the result of bleeding
from reputered cerebral artery or bleeding into site of
acute ischemic stroke.
• Haemorrhagic stroke can induce intracerebral
haemorrhagic or less commonly sub acchanoid or
intraventricular haemorrhage.
46. Perinatal stroke
• Where diagnosis occurred or is presumed to have
occurred between 28 weeks gestation and 8 days of life
or
• Childhood stroke
• which is defined by stroke occurring
between 29 days and 18 years of ahe.
47. Delayed presentation causes
• Childhood stroke is often overlooked by health care
professionals.
• Limited stroke awareness in pediatric population.
• The high frequency of stroke mimics.
• The diversity of prenting symptoms.
• The difficulty in examination and identifictionof
subtle symptoms in young children.
• Delayed access to diagnostic
neuroimaginexpertise.
48. Clinical presentation
• Clinical presentation of pediatric stroke varies
depending upon stroke type,vessels involved,and
child age.variation in clinical presentation is cited
as factor in missed or delayed.
• The International pediatric stroke study (IPPS)
• describes the presenting features of 676 children
diagnosed with arterial ischemic stroke.
• 80% presented wih hemiparesis.
• 51% presented with speech disturbance.
• 52% with altered conciousn
• 40% with head ache and 31% with seizures.
49. History
• Motor deficit
• Wekness of one half of body /any part of body.
• Isi it a vascular event?? ( arterial/vascular)
• Onset
• very sudden onset seconds embolic
• just sudden mintues haemorrhagic
• slowly sudden hours thrombotic
• gradual demylination
• Duration
• P site, static/progressive,max onset with rapid recovery (embolic)max
at onset with static phase (hemorrhagic).min at onset with slow max
at presentation (thrombotic).
50. History…….
• R relapse and remission
• A Associated symtoms .
• Cranial nerves involvement
• Any hx of double vision/change in vision,hearing
,smell,taste,facial deviation,drooling,change in
voice,/hoarness,nasal/regurgitation,hoking on
feeds.
• Sensory involvement
• Hx of tingling ,numbness or altered sensation in
any limb.
51. HX
• BASAL GANGLIA : movement disorder
• Thalamus : necrolapsy
• Area of postrema:nausea,vomiting, hiccups
• Spinal card : urinary or bowel dysfunction,sensory
loss.
52. Questions regarding DD
• ARTERIOPATHY
• INFECTIONS: Hx of fever ,head ache ,vomiting,fits,ASOS,neck
pain.
• PAST VARICELLAANGIOPATHY: hx of fever ,flu and rash.
• TRAUMATIC CAROTID/VERTIBERAL ARTERY
DISSECTION:
• hx of trauma to head and neck.
• SEC TO VASCULITIS:skin rashes /nodules/joint
pain/hematuria /HTN/lower limb swelling,oral ulcers
• MOYA MOYA :recurrent head ache,epilepsy,MR,focal
abrupt deficit
53. cardiac
• Sob,palpitation,orthopenia,body swelling,hx of cyanotic
episodes,hx of any surgery
• Hematological:
• paloor,patechie, bruises,bleeding from an
site,,need for blood transfusion.
• Neurocutenous syndromes:
• any mark on body
54. Metabolic
• MELAS: hx of developmenetal
regression,mayoclonic jerks
• MMA/PA : Episodes of encephalopathy,abnormal
movement ,ID,SEIZURES
• HOMOCYSTENURIA:visual
issue,ID,seizures,skeletal abnormalities.
• FABRYS:skin rashes ,acropresthesia and catract
55. VENOUS INFARCTION
• Csvt:
• head ache,vomiting,visual problems
otitis media,dental abcess,pharyngitis.
• Sepsis ,dehydration
• Demylination gradual onset, can rapidly .
• progressive, relapse and remitting course,
• Alternating hemiplegia of childhood.
57. examination
• Introduction ask the childs age , name , school(
any dysplasia,intellectual impairement)
• Inspection posture,asymmetry of limbs( growth
arrest),tall complexation,skeletal deformity (
homocysteneuria)or hemineglect
• Gait gait movement +fog test will detect subtle
hemiplegia
• Motor bulk , tone ,power
,reflexes,planters,superficial abdominal reflexes.
58. Examination
• Detailed cranial nerve involvement
• ECOM H
• Pupillary reflexes
• CNVII
• Bulbar involvement (xi,x)
• asymetric shoulder shrugging xi
• Tongue deviation xii
• Check visual field
59. Continued…..
• Cortical sensation LOCALIZATION
• asterognosis : ( unable to recognize key in hands)
• apraxia :
(show me ho you you bursh your teeth )
• Higher centers : names of body parts
• show watch and ask what is this ? A cat ,
dog .
• If CN AND HMF intact
• Examine spine and sensation
60. GPE AND Relevant
• Pallor ,petechae, bruises,neurocutenous
stigmata,joints
• Cvs exam including clubbing
• Bp ,carotid bruit
• Abd :liver and spleen.
61.
62.
63.
64.
65.
66.
67. stroke mimcs
• Status epilepticus
• Todds paesis
• Acute raised intracranial pressure
• Traumatic brain injury
• Central nervous system infection
• Demylinating disorders
• Complicated migraine
• Post infectious cerebellitis
68. Investigations
• Neuroradiology: CT/MRI followed by angiograph
/venography
• Cariac :ECG,CXR,ECHO
• Hematological CBC,PT,APTT,PROTIEN C,S ,AT
III,peripheral film or HBE
• Immune panel
• Carotid Doppler
• Supportive where indicated:culturesCSF
C/E,glucose ,metabolic screening
69. ACUTE SUPPORTIVE CARE
• Most crucial : mismatch between supply and demand
• Early identification of ischemia prevents infarction.
• Vigorous neuroprotctive care
• Normotension,normothermia,seeizures
control,normoglycemia,isonatermia,
• Early identification and management of cerebral
edema especially large territory and posterior fossa
stroke
• No evidence to support therapeutic hypothermia or
prophylactic anticonvulsant.
70. Antiplatelates versus anti
coagulation
• Prevents acute reinfarction
• American stroke associatonguidlines state that
anticoagulation with low molecular heparin or
unfractionated heparin may be considered for upto
1 week after stroke if dissection
dvasculopathy,unrecognized heart disese or
significant hypercoagulability are not yet ruled out.
• The united kingdom royal collage of physicans
recommends asprin in the initial period and
anticoagulation if extracracranialarterial
dissection is confirmed.
71. cause based treatment
• Sick cell :exchange tansfudion
• CNS angitis ; immunomodulators,pulse therapy
• MOYA MOYA ;surgical intervention
72. Chronic treatment
• The risk of recurrence varies widely by cause from
6% to 40% for all the childs upto66% 5
years.AISrecurrence on children with documented
arteriopathy.
• Three available guidelinesrecomend
anticoagulation for secondary ischemic prophylaxis
if ther is confirmed dissectionsource,or certain
thrombophilias with the duration of treatment
depends upon the condition .
• Asprin (3 to 5mg/kg/day ) is reasonable for all
conditions in secondary stroke prevention.