1. Fever of unknown origin (FUO) is defined as a fever over 38.3°C for more than 3 weeks without a diagnosis after 1 week of investigation.
2. There are four main classifications of FUO: classic FUO, nosocomial FUO, neutropenic FUO, and HIV-associated FUO.
3. Infections, neoplasms, and noninfectious inflammatory diseases are the most common causes of classic FUO in adults, with tuberculosis, typhoid fever, and malaria among the leading infectious causes.
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
Dr Abdullah Ansari
PG-2 (Medicine)
AMU ALIGARH
A general approach to periodic paralysis....
(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies)
Pathophysiology
Epidemiology
Primary or familial periodic paralysis
Secondary periodic paralysis
Conventional classification of periodic paralysis
Classification of primary periodic paralysis based on ion-channel abnormalities
Clinical approach to a case of periodic paralysis
History of muscle weakness
Age of onset
Family history
Timing
Intensity
History of administration of certain drugs
Clinical examination
Differential Diagnosis
Laboratory investigations
Serum K+
CPK and serum myoglobin
ECG
EMG
Nerve conduction studies
Provocative Testing
Muscle biopsy
Treatment
Prognosis
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
Dr Abdullah Ansari
PG-2 (Medicine)
AMU ALIGARH
A general approach to periodic paralysis....
(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies)
Pathophysiology
Epidemiology
Primary or familial periodic paralysis
Secondary periodic paralysis
Conventional classification of periodic paralysis
Classification of primary periodic paralysis based on ion-channel abnormalities
Clinical approach to a case of periodic paralysis
History of muscle weakness
Age of onset
Family history
Timing
Intensity
History of administration of certain drugs
Clinical examination
Differential Diagnosis
Laboratory investigations
Serum K+
CPK and serum myoglobin
ECG
EMG
Nerve conduction studies
Provocative Testing
Muscle biopsy
Treatment
Prognosis
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
Pneumonia - Community Acquired Pneumonia (CAP)Arshia Nozari
An overview to Community Acquired Pneumonia; It's Pathophysiology, Etiology, Epidemiology, Diagnosis and Treatment according to Harrison's Internal Medicine, 20th Edition (2018).
Evento Vascular Cerebral Pericateterismo Cardiaco Tratado con Stent a Arteria Cerebral Media. Dr. Juan Carlos Becerra Martínez. Tecnológico de Monterrey, Campus Guadalajara.
Stroke after cardiac catheterization.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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
1. DR. JUAN CARLOS BECERRA MARTÍNEZ
CÁTEDRA DE MEDICINA INTERNA-MC3087
TECNOLÓGICO DE MONTERREY, CAMPUS GUADALAJARA
2. Definition and Classification
Fever of unknown origin (FUO):
Was defined by Petersdorf and Beeson in 1961 as:
○ 1.- Temperatures of >38.3°C
○ 2.- A duration of fever of >3 weeks
○ 3.- Failure to reach a diagnosis despite 1 week of inpatient
investigation.
Durack and Street have proposed a revised
classification:
1.- Classic FUO
2.- Nosocomial FUO
3.- Neutropenic FUO
4.- FUO associated with HIV infection.
Harrison’s 18th Ed.
3. Definition and Classification
Classic FUO:
This newer definition is broader, stipulating
three outpatient visits or 3 days in the hospital
without elucidation of a cause or 1 week of
"intelligent and invasive" ambulatory
investigation.
Harrison’s 18th Ed.
4. Definition and Classification
Nosocomial FUO:
Fever >38.3°C develops on several occasions in
a hospitalized patient who is receiving acute care
and in whom infection was not manifest on
admission.
3 days of investigation and including at least 2
days’ incubation of cultures.
Harrison’s 18th Ed.
5. Definition and Classification
Neutropenic FUO:
Temperature >38.3°C
Neutrophil count <500/ml
3 days of investigation
2 days’ incubation of cultures
Harrison’s 18th Ed.
6. Definition and Classification
HIV-associated FUO:
Fever >38.3°C
>4 weeks for outpatients or >3 days for
hospitalized patients
HIV infection
Appropriate investigation over 3 days, including 2
days’ incubation of cultures.
Harrison’s 18th Ed.
8. Classic FUO in Adults
Infections:
Is the #1 cause of Classic FUO
Tuberculosis, typhoid fever and malaria remain a leading diagnosable cause
of FUO.
Others:
○ CMV, EBV, HIV
○ Intraabdominal abscesses
○ Osteomyelitis
○ Endocarditis
○ Prostatitis, dental abscesses, sinusitis, and cholangitis
○ Fungal diseases: histoplasmosis, paracoccidioidomycosis and
coccidioidomycosis
○ Chikungunya virus
○ Cryptococcus neoformans
○ Plasmodium
○ Babesiosis
Harrison’s 18th Ed.
9. Classic FUO in Adults
Neoplasms:
Are the next most common cause of FUO after
infections
Noninfectious inflammatory diseases:
Systemic rheumatologic or vasculitic diseases:
○ Polymyalgia rheumatica, lupus, and adult Still's disease
Granulomatous diseases:
○ Sarcoidosis, Crohn's disease, and granulomatous
hepatitis.
Harrison’s 18th Ed.
12. Classic FUO in Adults
Classic FUO in the elderly (>50 years):
Giant-cell arteritis is the leading etiologic entity in this
category (15–20% of FUO cases)
Tuberculosis is the most common infection causing
FUO in the elderly
Colon cancer is an important cause of FUO with
malignancy in this age group.
Harrison’s 18th Ed.
13. Classic FUO in Adults
Miscellaneous causes:
Drug fever
Pulmonary embolism
Factitious fever
The hereditary periodic fever síndromes:
○ Familial Mediterranean fever
○ Hyper-IgD syndrome,
○ TNF receptor–associated periodic syndrome (also known as
TRAPS or familial Hibernian fever)
○ Familial cold urticaria
○ Muckle-Wells síndrome
Congenital lysosomal storage diseases:
○ Gaucher's and Fabry's disease.
Harrison’s 18th Ed.
17. Classic FUO in Adults
Drug-related etiology:
Virtually all classes of drugs can cause fever:
○ Antimicrobial agents (b-lactam antibiotics)
○ Cardiovascular drugs (quinidine)
○ Antineoplastic drugs
○ Drugs acting on the central nervous system: phenytoin
Harrison’s 18th Ed.
18. Classic FUO in Adults
It is axiomatic that, as the duration of fever
increases, the likelihood of an infectious cause
decreases.
Harrison’s 18th Ed.
20. Nosocomial FUO
More than 50% of patients with nosocomial FUO are infected:
Intravascular lines, septic phlebitis, and prostheses.
The best approach is to focus on sites where occult infections may be
sequestered:
The sinuses of intubated patients or a prostatic abscess in a man with a urinary
catheter.
Clostridium difficile colitis.
In <25% of patients the fever has a noninfectious cause:
Acalculous cholecystitis, deep-vein thrombophlebitis, and pulmonary embolism.
Others: Drug fever, transfusion reactions, alcohol/drug withdrawal,
adrenal insufficiency, thyroiditis, pancreatitis, gout.
Harrison’s 18th Ed.
21. Nosocomial FUO
Multiple blood, wound, and fluid cultures are
mandatory.
20% of cases of nosocomial FUO may go
undiagnosed.
In many hospital settings, empirical antibiotic therapy
for nosocomial FUO now includes vancomycin for
coverage of S. Aureus as well as broad-spectrum
gram-negative coverage with piperacillin/tazobactam,
ticarcillin/clavulanate, imipenem, or meropenem.
Harrison’s 18th Ed.
22. Neutropenic FUO
Neutropenic patients are susceptible to focal bacterial and fungal
infections:
Bacteremic infections,
Infections involving catheters
Perianal infections.
Candida and Aspergillus infections are common. Others: Herpes
simplex virus or CMV
50–60% of febrile neutropenic patients are infected, and 20% are
bacteremic.
The IDSA dictates the use of vancomycin plus ceftazidime,
cefepime, or a carbapenem with or without an aminoglycoside to
provide empirical coverage for bacterial sepsis
Harrison’s 18th Ed.
23. HIV-Associated FUO
HIV infection alone may be a cause of fever.
Mycobacterium avium or M. intracellulare, tuberculosis, toxoplasmosis,
CMV infection, Pneumocystis infection, salmonellosis, cryptococcosis,
histoplasmosis, strongyloidiasis
Non-Hodgkin's lymphoma
Of particular importance drug fever are all possible causes of FUO.
Blood cultures and by liver, bone marrow, and lymph node biopsies.
Chest CT should be performed to identify enlarged mediastinal nodes.
FUO has an infectious etiology in >80% of HIV-infected patients.
Harrison’s 18th Ed.