Meningitis is an inflammation of the meninges, the membranes surrounding the brain and spinal cord. There are different types including acute pyogenic and acute arpe meningitis. Symptoms include severe headache, neck stiffness, fever, vomiting, sensitivity to light and sound. Diagnosis involves lumbar puncture to examine cerebrospinal fluid for increased white blood cells, protein levels and decreased glucose. The patient presented with headache and fever and was diagnosed with acute meningitis based on clinical findings and CSF analysis showing lymphocytic pleocytosis. Treatment involved antibiotics, antivirals, analgesics and other supportive medications.
Rhonda Cadena explains the process of diagnosing and managing meningitis. It is a skill that involves rapid identification, workup, and treatment. In most cases, the diagnosis of meningitis is not a diagnostic dilemma, but the workup and treatment are not as straightforward.
Meningitis is inflammation of the lining of the brain and spinal cord. This can be caused by bacteria, autoimmune process, drug reactions, viruses, and fungi. Rhonda delves deeper into bacterial meningitis. Worldwide there are over 1 million cases per year of bacterial meningitis. This equates to 135 000 deaths. Of the survivors, half will be left with neurological deficits. So, the swift identification and treatment of this disease process is crucial.
Symptoms include fever, headache, nuchal rigidity and altered mental status with almost all patients having at least two. A lumbar puncture is absolutely necessary. Only insist on a CT first if you suspect a mass lesion or increased intracranial pressure. Otherwise, the delay in antibiotics can lead to an increased morbidity and mortality.
Labs are next in the workup. All the common labs should be ordered along with a procalcitonin which can be diagnostic for a bacterial infection (although it will be positive with any bacterial infection so make sure it fits the clinical picture!) Likewise, fungitell can be useful in looking for some of the more common fungal infections.
Blood cultures will guide antibiotic coverage. Steroids can be beneficial for prevention of neurological sequalae in patients who are infected with pneumococcal meningitis. They should be started in anyone with suspected meningitis. You can then cease if cultures come back negative for pneumococcus. Importantly steroids must be started before or during antibiotics.
Finally Rhonda discusses prophylactic treatment. This is necessary for contacts of patients with Neisseria infections. Think household member, day care contacts, and anyone exposed to secretions.
This scintillating talk addresses the challenges during the workup, which labs to send during the initial workup, and how specialized labs such as CSF lactate, procalcitonin, and fungitell may help in the workup along with helpful advice for management.
Rhonda Cadena explains the process of diagnosing and managing meningitis. It is a skill that involves rapid identification, workup, and treatment. In most cases, the diagnosis of meningitis is not a diagnostic dilemma, but the workup and treatment are not as straightforward.
Meningitis is inflammation of the lining of the brain and spinal cord. This can be caused by bacteria, autoimmune process, drug reactions, viruses, and fungi. Rhonda delves deeper into bacterial meningitis. Worldwide there are over 1 million cases per year of bacterial meningitis. This equates to 135 000 deaths. Of the survivors, half will be left with neurological deficits. So, the swift identification and treatment of this disease process is crucial.
Symptoms include fever, headache, nuchal rigidity and altered mental status with almost all patients having at least two. A lumbar puncture is absolutely necessary. Only insist on a CT first if you suspect a mass lesion or increased intracranial pressure. Otherwise, the delay in antibiotics can lead to an increased morbidity and mortality.
Labs are next in the workup. All the common labs should be ordered along with a procalcitonin which can be diagnostic for a bacterial infection (although it will be positive with any bacterial infection so make sure it fits the clinical picture!) Likewise, fungitell can be useful in looking for some of the more common fungal infections.
Blood cultures will guide antibiotic coverage. Steroids can be beneficial for prevention of neurological sequalae in patients who are infected with pneumococcal meningitis. They should be started in anyone with suspected meningitis. You can then cease if cultures come back negative for pneumococcus. Importantly steroids must be started before or during antibiotics.
Finally Rhonda discusses prophylactic treatment. This is necessary for contacts of patients with Neisseria infections. Think household member, day care contacts, and anyone exposed to secretions.
This scintillating talk addresses the challenges during the workup, which labs to send during the initial workup, and how specialized labs such as CSF lactate, procalcitonin, and fungitell may help in the workup along with helpful advice for management.
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
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
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
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
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
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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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.
2. MENINGITIS Definition: It is an inflammation
of the MENINGES, the three membranes that
envelope the brain and spinal cord
TYPES OF MENINIITIS:
1.Acute Pyogenic Meningitis
2. Acute Arpe Meningitis
3. Chronic Meningitis
3.
4. Clinical Manifestations
Severe Headache
Nuchal Rigidity(neck stiffness)
High fever,chills.vomiting
Photophobia
Phonophobia
A bulge in soft spot on top of a baby`s
head(fontanel)
Kernig sign(inability to straighten leg when
the hip is flexed to 90 degrees)
Young child: leg pain, cold
extremities,abnormal skin colour,seizures
5. Exposure to pathogen and colonization of
micro organism at Naso oropharnyngeal
mucosa
Entry into blood stream and inflammation of
meninges
Attachment to mucosal surface and changes in
CSF
Secondary brain damage
6. Result:
Vascular endothelial inflammation
Increase BBB permeability
Entry into blood component and
sub-arachnoid space
Cerebral edema
Increase CSF proteins and ICP
Decrease blood flow
Permanent neuronal injury
/dysfunction
7. 1. CSF-Lumbar puncture L3-L4 and L4-L5 –
cloudy appearance/purulent
2. Increase in Neutrophils[90,000/mm3]
3.Increase in Protein level[>100 or500]
4.Decrease Glucose levels [<50%]
Ranges in meningitis:
Lymphocyte Protein Glucose
Bacteria 50-2000 1-3 <50%
TB 100-600 1-6 <50%
Viral 5-500 0.5-1 Normal
Fungal 50-1000 1-3 <50%
8. SUBJECTIVE DATA
PATIENT NAME: XYZ
AGE: 27yrs
GENDER : Male
DOA:15/12/18
DEPT:General ward
PATIENT COMPLAINTS: Head ache
Fever on and off
Body pains(mild)
PRESNT ILLNESS: 27yr old male patient was
admitted with history of above complaints came
here for further evaluation and management
PAST MEDICAL HISTORY: Allergy to Pencillin
9. OBJECTIVE DATA
1.Day to day assesment and Vital signs
Day 1:
Temp:98.4˚F
bp:130/80mmHg
PR:58 bpm
RR:20bpm
Spo2:98%
O/E Pt conscious /cohrent
headache+
blurred vision on and off
11. Day 4
High protein diet recommended
No fresh complaints
2.LAB INVESTIGATION
Hematology
TEST RESULT NORMAL
RANGE
Hb 14.50gms% 12-15gms%
RBC 5.09Million/cumm
4.5-5.5
million/cumm
Platelet count 2.75lakhs/cumm 1.5-4.1
lakhs/cumm
PT-T 28sec 25-35sec
INR 1.09 0.9-1.2
12. Differential count
TEST RESULT Normal range
WBC 9,986 /microlitre 4k—10k/microlitre
Eosinophils 4.30% 1-6%
Monocytes 5.40% 2-10%
Basophils 0.60% 0.5-1%
Neutrophils 9,149/mm3 1500-8k/mm3
lymphocytes 1,990/microlitre 1k-4800/microlitre
13. Renal function tests
Liver function tests
TEST RESULT Normal Range
Sr.urea 14.00mg/dl 7-20mg/dl
Sr.creatinine 0.80mg/dl 0.6-1.2mg/dl
Blood urea
nitrogen
6.54mg/dl 9-20mg/dl
TEST RESULT Normal Range
Protein 17.3g/dl 6.8-8.3g/dl
glucose 52mg/dl 70-130mg/dl
14. CSF Results
Quantity -2ml
Appearance clear and colourless
Reaction alkaline
CSF FOR CYTOLOGY
Cellular smear shows lymphocytic
pleocytosis composed predominantly of
mature and transformed cells
Few monocytes, and pia archonoid
meningothelial cells are seen
IMPRESSION: Lymphocytic Meningitis
15. ACID FAST BACILLI SMEAR
Polymorphs few
No AFB seen
SMEAR FOR FUNGAL ELEMENTS
Negative
SMEAR FOR GRAM STAIN
Polymorphs few
No micro organism seen
ECG and X-RAY: normal
TB: not detected
16. ASSESMENT
Based on subjective and objective
data the patient is diagnosed with ACUTE
MENINGITIS
17. PLAN
Medication chart:
Drug Generic name dose frequ
ency
ROA Da
y 1
Da
y 2
Da
y 3
Da
y 4
Da
y 5
Inj monocef Ceftriaxone 2g BID IV + + + + +
Inj acyclovir Acyclovir 500µg BID IV + + + + +
Inj PCM paracetamol 100ml SOS IV + + + + +
Inj PAN Pantoprazole 40mg PO IV + + + + +
Inj mannitol mannitol 20% BID IV + + + + +
IVF DNS Dextrose
normal saline
30ml/
hr
IV + + + + +
18. DRUG Generic
Name
Dose Frequ
ency
ROA Da
y 1
Da
y2
Da
y 3
Da
y 4
Da
y 5
Inj zofer ondansetro
n
40mg SOS IV + + + + +
Inj optineuron Vit B1, B2,
B3,B5 B6,
B12,
1g OD IV - + + + +
Inj dexona dexamethas
one
4mg BID IV - + + + +
syp duphalac lactulose 30ml HS PO - - - + +
19. Drug Class MOA Side effects Uses
Inj Monocef 3rd gen
cephalspori
n
Inhibit mucopeptide
synthesis in bacterial
cell wall resulting in
cell death
Allergic rxns
Diarrhea
Seizures
leukopenia
To treat bact
infection
InjAcyclovir Antiviral
drug
Inhibits viral DNA
polymerase results in
viral replication
N,V,D,
Visual
changes,hair
loss
Viral
infection
treated
Inj PCM Antipyretic
analgesic
Selective cox-2
inhibition
Constipation
Inj site rxn
To reduce
pain and
fever
Inj Mannitol Osmotic
diuretic
Elevates blood
plasma osmolarity
causing enhanced
flow of water from
tissues, brain and csf
VolumThrom
bophlebitis,
Hypernatrem
ia
tachycardia
e
Lowers ICP,
CSF
20. DRUG CLASS MOA Side effects uses
Inj zofer Anti
emetic
Blocks serotonin
receptors in CTZ
reuces communication
with vomitting center
QT prologantion
Otototxicity
Allregic rxn
Nausea and
vomiting
Inj
Optineur
on
Multi -
Vitamin
vitB2 may lead to
slight improvements in
motor function,
cognitive behavior, and
diarrhea in this
disorder.
Increase blood
sugar levels
N, D
VITAMIN B
deficency
Inj PAN PPI Inhibits gastric acid Arthralgia
flacutence
Decreases
acidity
21. Drug class MOA Side effects Uses
Inj Dexona corticosteroid unclear HTN,
Dyspepsia
Cataract(10%
)
Regulate
inflammation
response and
cover CSF
pressure
Syp Duphalac Laxative Increase in
stool water
and soft stool
[bcoz
constipation
may lead to
fever]
Bleaching
Excessive
bowel activity
Treat
constipation
22. Goals of treatment
Eradication of infecting organism
Management of CNS and systemic
complications
Reduce the fever, headache, and body
pain
Photophobia and phonophobia should be
treated
23. PATIENT COUNSELLING
Advice the patient that prophylactic
treatment may be indicated and they
should visit their health care providers
Encourage patient to follow medication
regimen as directed
Prompt attention to infection in future
24. Monitoring parameters
Neutrophils levels should be monitored
Glucose levels should be monitored
Protein levels should be monitored
Vitals should be checked regularly
ICP pressure(normal range 5-15mmHg)
25. LIFE STYLE MODIFICATIONS
Regular Exercise:
Eg: stretching exercises due to stiff neck
Balancing exercises such as standing
with eyes closed, standing on one leg.
This is important as they need balance
for tasks such as walking,running etc.
Co-ordination exercise such as catching
balls,kicking football.
26. DIET
Food to be taken
Fruits like watermelon, berries, grape fruit,
papaya.
Vegetable like broccoli, red capsicum,
carrot, cabbage, leafy green vegetables.
Adequate fluid intake
27. FOODS TO BE AVOIDED
Sugary food
White flour food
Processed food
Smoked fish
Alcohol/caffeinated beverages
28. PRECAUTIONS
Follow the medication as per the
prescription
Do not miss the dose
Do not double the missed dose
If any side effects/ADR`s seen report
it to physician