Complicated Pediatric Pneumococcal Meningitis - Case PresentationFatima Farid
A unique case report of pneumococcal meningitis complicated by diffuse vasculitis and severe neurologic debility. Child displayed remarkable recovery with steroid therapy despite prolonged severe disease course!
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Complicated Pediatric Pneumococcal Meningitis - Case PresentationFatima Farid
A unique case report of pneumococcal meningitis complicated by diffuse vasculitis and severe neurologic debility. Child displayed remarkable recovery with steroid therapy despite prolonged severe disease course!
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Nursing care management of child with respiratory distressMounika Bhallam
NURSING CARE MANAGEMENT OF CHILD WITH RESPIRATORY DISTRESS; this topic will give information regarding respiratory distress and management for mild and moderately distressed child. Mainly mentioned about infection prevention and control triage measures.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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
1. Guidelines for prescriping of
long acting pencillin and
value of ASO Titer
By
Dr. Magdy Shafik
Ph. D of Pediatric
Pediatric Consulatant
2. Antibiotic Therapy for GABHS
Goal is bacteriological cure.
Antimicrobial therapy as early as before 9th
day of illness.
Duration of therapy (10 days coverage).
– 10 days: oral penicillin (V)/Amoxacillin/1st
generation cephalosporin.
– Single IM, Benzathin penicillin.
– 10 days: erythromycin ethylsuccinate.
– 5 days: Azithromycin.
– 7 days: Clarithromycin,
3. The Requirements for the Development of RF
Genetically Predisposed Host.
PLUS
Presence of GABHS.
Pharyngeal infection not
colonization.
Persistence of the organism in the
pharynx for a sufficient period (delay
of therapy > 9th day or treatment <
10 days duration) or subclinical
infection.
Streptococcal immune response
(anti-streptococcal antibodies).
4. What makes a link between the throat
and the heart ?
5. Major and Minor Manifestations of Rheumatic Fever
Carditis
Polyarthritis
Chorea.
Erythema Marginatum
Subcutaneous nodules
Fever
Arthralgia
Elevated acute phase reactants (ESR,
CRP)
Prolonged P-R interval
PLUS
Evidence of preceding streptococcal infection (Culture, rapid antigen,
antibody rise / elevation)
Minor criteriaMajor criteria
6. Sequences of RF Manifestations
20 30 50 100 200
20 30 50 100 200
Subcut. Nodules
Erythema Marginatum
Chorea
Carditis
Arthritis
Abdominal pain
ASO titer
Days since strept. infection
7. Growing pains
Joint pains of subacute
rheumatic fever
Growing pains
Timing Durring entire day,
disappears on getting warm
in bed, worse on first getting
out of bed in the morning.
At end of day or
soon after falling
asleep, free of
pain in morrning
Location In joints. Pain on motion.
Cild points out pain in joints.
Involves joints in upper
extremities.
May cause limping.
In muscles of
thigh or legs. No
pain on motion.
Child vague in
pointing out site
of pain in upper
extremites
unusual.
8. Massage addressed by general pediatrician to parents
of children with growing pain
1-The pain is related to the muscle and has no relation
to the joint or the heart
2- The pain is very common, benign phenomenon in
children and usually related to increased day time
motor activity.
3- The child’s pain is completely unrelated to
streptococcal sore throat( you must repeat)
4-The child does not need any further special testing as
ESR or ASO or any sort of therapy apart from massage
or mild analgesic, if distressing or interfering with
sleep.
5-Any restrictions or precautions are not only
unnecessary but wrong.
9. 6-The pain may come and the pain may go, and is
self limiting by age but the child health is normal.
7-The child should keep physical active.
10. Myths that Should be Condemned in the
Diagnosis of RF X
Any vague musculoskeletal pain during or following GABHS pharyngeal
infection supported by high ESR and elevated ASO titer is mostly related
to RF.
The lack of migratory character of polyarthritis is a strong predictor against
RF
Echocardiography is only confirmative to clinically evident carditis .
Patients with Post-streptococcal reactive arthritis should not receive
prophylactic BPG, being a separate disease entity.
Rheumatic fever is a primarily laboratory diagnosis ,so that a high
ESR/CRP plus elevated ASOT make the diagnosis of RF more likely.
A markedly elevated titer of ASO is only seen in patients with ARF.
ASO titer is a diagnosis by itself ,regardless the clinical setting of the
patient to whom the test is requested.
11. ASO Titer
WHAT IS ASO Titer ?
IS A titer of antistreptolysin O which is one of the
streptococcal antibody
IS THERE IS ANY other streptococcal antibody ?
DNA se –B
NAD ase
Streptokinase
hyalourindase
13. III-The Diagnostic Utility of High ASO
Titer
15% of normal children without clinical evidence of recent GAS infection
have a titer exceeding the ULN .
About 20% of patents with the first attack of RF and many patients with
chorea, all have low ASO titer .
In case of negative rising titer, other antibodies, such as anti-DNaseB and
anti-hyaluronidase, should be performed in order to improve the capacity
to confirm a previous infection.
In most of developing countries, where the incidence of RF is high and
resources are limited, the only test available is ASO.
It seems better to diagnose a suspected case with typical migratory
polyarthritis ,despite a normal ASO titer as RF, after exclusion of other
causes .
A low or non rising ASO titer at the onset of isolated polyarthritis is not
necessary a negative predictor of RF .
14. Diagnostic Significance of Higher ASOT
More Than 400 in Different Clinical
Scenarios
All these scenarios are not indication for
ordering ASO titer in the daily clinical practice:
A symptomatic child or with minor symptoms :
a completely healthy child (15%) or subclinical GAS
infection in the preceding 3-6 month
History suggestive of sore throat or clear evidence of
tonsillitis: GAS infection in the preceding 3-6 month
Recurrent symptomatic or subclinical pharyngitis:
elevated titer is suggestive of GAS infection in the
preceding 3-6 month
Acute tonsilopharngitis : not related to the current
infection
15. All these scenarios are indication for
ordering ASO titer in the daily practice:
1- Acute migratory polyarthritis or acute carditis:
support the diagnosis of initial attack of acute
rheumatic fever
2-Isolated chorea or indolent carditis:
support the diagnosis of rheumatic fever
3-Patient with polyarthalagia or Monoartheritis and
positive acute phase reactant :
support the diagnosis of initial attack of
probable rheumatic fever
16. 4-patient with past history of RF or RHD with fever or arthralgia
with positive acute phase reactant :
a rising titer support the diagnosis of recurrence.
5- A symptomatic patient with past history of RF, Chorea or
RHD on follow up:
support the diagnosis of GAS and so poor compliance and
hence prophylaxis failure
6-Patient with symptoms suggestive of AGN :
support the diagnosis of GAS
17. Guidelines for the prescriping of long
acting penicillin
1-Initial attack of acute rheumatic fever or recurrence :
to eradicate Group A B- Hemolytic strpt. Cocci. Prior to
prophylaxis. ONCE
2-Pasthistory of rheumatic fever, chorea, or established
RHD (secondary prevention) . / 2 WEEKES
3- Acute tonsilopharnigitis suggestive of Group A B-
Hemolytic strpt. Cocci infection: for a bacteriological cure
for the benefit of the patient and community . ONCE
18. 4- Acute Poststrptoccol GN
: for a bacteriological cure for the benefit of the community .
ONCE
5- Recurrent symptomatic tonsliopharnigitis suggestive of
Group A B- Hemolytic strpt. Cocci infection with a frequencies
not necessitating tonsillectomy:
to decrease the frequency of infections, antibiotic therapy,
school abestansism and superlative complication,
EVERY 2-3 WEEKS FOR HOW LONG??? And in what
season ?? INDVIDULAZED ….
19. In cases of sensitivity to Lon acting penicillin use
erythromycin 250 mg once daily(↓ 27 year) if (↑ 27
year give 250 mg twice daily
20. Duration depends on clinical presentation and cardiac extent of
ARF.
1-Patients without rheumatic carditis require prophylaxis for 5
years or until age 21, whichever comes later.
2-Patients with a history of rheumatic carditis but with no
residual cardiac disease (clinical or echocardiographic) require
prophylaxis for at least 10 years and well into adulthood,
whichever is longer.
3-Patients with rheumatic heart disease should have prophylaxis
for at least 10 years and at least until 40 years of age.
Duration of secondary infection by LAP
21. 1- The most common cause of syncope in pediatric is Neuromediate
syncope .
2-The most common cause of chest pain in children is muscloskeletal or
pulmonary
3-The most common cause of palpitation in children is NON Cardiac,
Physiological.
4-The most common cause of exercise intolerance in children is NON
Cardiac : exercise induced asthma.
5-The most common cause of murmur in children is innocent murmur.
Remember the following 10 facts
22. 6-The most common cause of leg pain in children is
growing pain
7-The most common cause of tachycardia in children is
emotional
8-The most common cause of pseduhypertesion in
children is white coati HTN
9-The most common cause of CYNOSIS in the daily practice is
ACROCYNOSIS
10-The most common cause of Subjective Feeling of
Dyspnea in a previously healthy adolescent girl is
Sighing Breathing in response to stressor