This document provides information about a patient diagnosed with pulmonary tuberculosis (PTB) and pancytopenia. Key details include:
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- The patient was diagnosed with RVD-positive PTB and pancytopenia. Treatment included anti-TB medications and supplements to increase blood counts.
- The patient showed improvement over a week-long hospital stay, with reduced symptoms and increased hemoglobin. They were discharged on a 90-day course of anti-TB drugs and supplements.
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
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A blockage of blood flow to the heart muscle. A heart attack is a medical emergency.A heart attack usually occurs when a blood clot blocks blood flow to the heart.Without blood,tissues loses oxygen and dies
This powerpoint is a case presentation, that explains the case of ADCHF, with comorbidities, comprising HTN, CAD and DLP.
A summary on the recent advancements in HF management, along with justification of therapy provided, has been elucidated.
A note on home remedies and counselling tips has also been provided.
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
A 28 year old male patient was admitted to the male medicine ward with complaints of fever since 1 week, bodyache, headache, slightly yellowish sclera and watery eyes.
A blockage of blood flow to the heart muscle. A heart attack is a medical emergency.A heart attack usually occurs when a blood clot blocks blood flow to the heart.Without blood,tissues loses oxygen and dies
This powerpoint is a case presentation, that explains the case of ADCHF, with comorbidities, comprising HTN, CAD and DLP.
A summary on the recent advancements in HF management, along with justification of therapy provided, has been elucidated.
A note on home remedies and counselling tips has also been provided.
A 70-year old male patient was admitted to the male medicine wards with complaints of cough with expectoration since 20 days, anorexia, pedal oedema, chest pain, haemoptasis since 10 days, low grade fever, weakness.
Seizures which affect initially only one hemisphere of the brain. Symptoms include:
Contractions on just one side of the body
unusual head or eye movements
Numbness, tingling, or a feeling that something is crawling on the skin
Abdominal pain
Rapid heart rate or pulse
Sweating
Nausea
RNTCP guidelines for tuberculosis management: Extended versionRxVichuZ
This presentation is an extension of the already made presentation before, that deals with RNTCP guidelines for some special aspects encountered during tuberculosis management, other than management of individual diagnoses alone.
Have a look!
Scrub typhus is a growing and emerging disease grossly under-diagnosed due to its non-specific clinical presentation, limited awareness, and low index of suspicion
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WEIL FELIX test very Specific
Early diagnosis and treatment are imperative to reduce the mortality and the complications associated with the disease
A 70-year old male patient was admitted to the male medicine wards with complaints of cough with expectoration since 20 days, anorexia, pedal oedema, chest pain, haemoptasis since 10 days, low grade fever, weakness.
Seizures which affect initially only one hemisphere of the brain. Symptoms include:
Contractions on just one side of the body
unusual head or eye movements
Numbness, tingling, or a feeling that something is crawling on the skin
Abdominal pain
Rapid heart rate or pulse
Sweating
Nausea
RNTCP guidelines for tuberculosis management: Extended versionRxVichuZ
This presentation is an extension of the already made presentation before, that deals with RNTCP guidelines for some special aspects encountered during tuberculosis management, other than management of individual diagnoses alone.
Have a look!
Scrub typhus is a growing and emerging disease grossly under-diagnosed due to its non-specific clinical presentation, limited awareness, and low index of suspicion
consider as a differential diagnosis in acute febrile illness with thrombocytopenia, renal impairment, LFT abnormalities, altered sensorium,encephalitis, pneumonitis, or ARDS
WEIL FELIX test very Specific
Early diagnosis and treatment are imperative to reduce the mortality and the complications associated with the disease
3. a case study on plasmodium falciparum with thrombocytopenia with viral hep...Dr. Ajita Sadhukhan
A 20-year old male patient was admitted to the male medicine ward with complaints of fever with chills since 1 week, headache, abdominal pain, nausea, vomiting, yellowish sclera, yellowish urine, anorexia, general weakness since 10 days.
Bovine tuberculosis: Occupational hazard in Abattoir workersiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Information about diagnostic methods and techniques for tuberculosis including microscopy, fluorescence microscopy, mycobacterial culture, molecular techniques (line probe assay, Xpert MTB/RIF), interferon gamma release assay (IGRA) and tuberculin skin test (TST)
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Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
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The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
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Ethnobotany and Ethnopharmacology:
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http://sandymillin.wordpress.com/iateflwebinar2024
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Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
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The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
2. DEFINITION
Tuberculosis is a chronic granulomatous disease
caused by Mycobacterium tuberculosis,which can
produce either a silent ,latent infection or a
progressive,active disease.
3. ETIOLOGY
Causative Organism:TB is caused by Mycobacterium
species.
In humans,infection by M.tuberculosis.
In animals,infection by M.bovis.
In Africans,infection by M.africanum
M.tuberculosis is an aerobic,non-spore forming
bacillus that resist decolourization by acid alcohol
after staining with basic fuschin....organism is referred
to as an acid fast bacilli(AFB).
4. PATHOPHYSIOLOGY
Airborne/droplet ingestion (cough, sneezing,speaking)
Droplet nuclei enter the respiratory tract and reach alveoli(bacteria enter
ciliary epithelium)
Initiation of primary infection(organisms multiply)
Activation of alveolar macrophages(phagocytosis of bacilli)
5. Persistence of organism(few in number)
Rupture of macrophages & release of bacilli
Organisms multiply, transport of bacilli by lymphatic system to other organs
Formation of gra nuloma(cell mediated immunity delayed type of
hypersensitivity by activation of CD4+T cells,secretion of INF gamma, IL )
Large number of macrophages surrounds the organism
6. In high immune people
disease may relapse after 2
yrs(latent tb infection)
In immune suppressed people tubercular
bacilli appear(rapid multiplication)
Active tb infection
7. CLINICAL PRESENTATION
SIGNS AND SYMPTOMS:
Weight loss,fatigue,a productive cough,fever,and night sweats.
Frank hemoptysis
PHYSICAL EXAMINATION:
Dullness to chest percussion,rales and increased vocal fremitus are
observed frequently on auscultation.
LAB TESTS:
Moderate elevations in WBC Count with a lymphocyte predominance.
Chest Radiograph:Patchy or nodular infiltrates in the apical areas of
the upper lobes or the superior segment of the lower lobes
Cavitation that may show air fluid levels as the infection progresses.
8. Definition
AIDS, the acquired immune deficiency syndrome(some
times called as slim disease) is a fatal illness caused by a
retrovirus known as the human immunodeficiency
virus(HIV) which breaks the body’s immune system, leaving
the victim vulnerable to a host of life-threatening
opportunistic infections, neurological disorders, or unusual
malignancies.
9. ETIOLOGY
AIDS is caused by HIV, a human retrovirus.
Two types- HIV I and HIV II which are genetically
different but has related forms.
HIV I is most common type associated with AIDS in US,
Europe and Central Africa.
HIV II causes similar disease in West Africa and India.
HIV-2 is transmitted less efficiently than HIV-1.
16. HISTORY OF PRESENT ILLNESS
Patient was apparently alright but 7 days back he
developed fever with chills,insidious in
onset,intermittent type.
No H/O rigors
H/O dry cough since 7 days.
H/O breathlessness since 7 days.
H/O generalised weakness +
23. LABORATORY DATA
11/12 13/12
Hb 3.3gm/dl(13.5-17.5) 6.0gm/dl
WBC 1500cells/µl(4500-10500) 1800cells/µl
POLYMORPHS 65%(40 -75) 53%
BASOPHILS 00(0-1) 00
EOSINOPHILS 3%(0-5) 2%
LYMPHOCYTES 32%(20-40) 45%
MONOCYTES 00%(0-7) 0%
RBC O.75mill/µ l(4.7-6.1) 1.53mill/µl
PLATELETS 60,000cells/µl(1.5-4.5
lakhs)
110000cells/µl
ESR 100mm at the end of the
1st hour
24. 11/12
RBS 112 mg/dl(60-140)
Sr . Urea 18 mg%(10-50)
Sr . Creatinine 0.9 mg/dl(0.6-1.2)
ALT 22 U/L(6-38)
AST 68 U/L(6-40)
ALP 122 U/L(35-140)
T . Bilirubin 0.8 MG%(0.2-1)
D . Bilirubin 0.3 MG %(0.1-0.4)
I . Bilirubin 0.5 MG %(0.1-0.6)
HIV - 1 Reactive
HBs Ag - ve
Albumin 3.1 gm %(3.5-5.2)
25. SPUTUM CULTURE SENSITIVITY TEST : organisms
isolated .
ZN stain : AFB seen
USG abdomen : moderate to gross ascitis.
Pus cells : 1-2/hpf
Epithelial cells : 0-1/hpf
26. TREATMENT CHART
BRAND
NAME
GENERIC NAME DOSE ROUTE FREQUENCY 1 2 3 4 5 6 7 8
Blood
Transfusion
PRBC
PACKAGED CELL
VOLUME
3 PINT IV
√ √
INJ.Taxim Cefotaxime 1gm iv 1-0-1 √ √ √ √ √ √
INJ.Pantakind Pantoprazole 40mg iv 1-0-0 √ √ √ √ √ √(
t)
√ √
INJ.Vitcofol
2 ml in 100ml
NS
folic
acid,vitaminB12,nic
otinamide
15mg,
0.15mg,200m
g
im 1-0-0 √ √ √ √ √ √ √ √
IVF DNS 2 pint iv 1-1-1 √ √ √
TAB.Sepmax
DS
Sulphamethoxazole
,trimethoprim
800mg,160m
g
p/o 1-0-0 √ √ √ √ √ √
TAB.Benadon Vit B6 40mg p/o 0-1/2-0 √ √ √ √ √ √
TAB.Akurit 4 INH,rif,pyr,ethamb
utol
75mg,150mg,
400mg,275m
g
p/o 3-0-0 √ √ √ √ √ √
43. PHARMACEUTICAL CARE PLAN
SUBJECTIVE EVIDENCE : c/o fever with chills since 1 week , c/o
cough since 1 week . Generalized weakness +ve
OBJECTIVE EVIDENCE :
HB : 6gm/dl ↓
WBC : 1500cells/ul ↓
RBC : 1.53mill/ul ↓
PLATELETS : 110000 cells/ul ↓
ESR : 100 mm at the end of the first hour ↑
HIV 1 : REACTIVE
CULTURE SENSITIVITY TEST : Organisms isolated
ZN stain : AFB seen
USG abdomen : moderate gross ascites
ALBUMIN : 3.1 gm%
44. ASSESSMENT : By observing the subjective and objective
evidences , the physician diagnosed it as “ RVD +ve , PTB ,
PANCYTOPENIA “
PLANNING:
GOALS OF THE THERAPY :
1. To decrease the fever , chills and cough .
2. To improve patient’s quality of life .
3. To make patient adhere to the medication .
4. To incease Hb and RBC counts .
5. To prevent further oppurtunistic infections.
6. To recommend the best ART regimen.
45. GOALS ACHIEVED
1. Fever, chills and cough reduced
2. patients quality of life is improved
3. Haemoglobin and RBC count is increased.
4. To inform patient caretaker to initiate the ART from GOVT.
Hospital .
PHARMACIST INTERVENTION
Anti-TB and ART drugs at same time involves a number of
potential difficulties including - Cumulative drug toxicities Drug
– drug interactions, A high pill burden and The Immune
Reconstitution Inflammatory Syndrome (IRIS)
1. Concurrent use of pyrazinamide and riampin may result in severe
hepatic injury – major – delayed onset.
46. 2. Concurrent use of rifmpin and isoniazid can cause
severe hepatic toxicuty, so monitor LFT.
MONITORING PARAMETER
CBC with ESR
LFT
CD4 COUNT
CLINICAL SYMPTOMS OF LIVER INJURY
47. TREATMENT
PHARMACOLOGICAL TREATMENT:
ANTI-TB DRUGS:Agents that are therapeutically
effective against TB.
First Line Drugs:They have high antitubercular
efficacy as well as low toxicity.
Isoniazid(H)
Rifampin(R)
Pyrazinamide(Z)
Ethambutol(E)
Streptomycin(S)
48. Second Line Drugs:They have either low Anti-TB
efficacy or high toxicity or both.
Thiacetazone(Tzn)
Para Amino Salicylic acid(PAS)
Ethionamide(Etm)
Cycloserine(Cys)
NEWER DRUGS
Ciprofloxacin
Azithromycin
Rifabutin
49. CATEGORY BASED TREATMENT
Category I:New positive pulmonary TB patients.
New severe extra pulmonary tuberculosis patients
Negative for pulmonary TB with extensive paranchymal
involvement.
Category II:Treatment failure due to resistance,inadequate
dose,uncompliance,relapse,multi-drug resistant TB
Category III:Less severe extra TB
Less negative for PTB with extensive parenchymal
involvement.
Category IV:Chronic disease
Multi-drug resistant TB
50. DOTS(Directly Observed Treatment
In Short Strategy)
H3R3Z3E3/S3 for 2 months +H3R3 for 4 months
Total therapy:6 months
DOTS Therapy is directed to following people:
Homeless people
History of non-medication adherence patients.
Chronic alcoholic
Active TB
TB with AIDS:2HRZE,Duration:9 months
Mycobacterium avium complex in AIDS due to immune
suppression.Clarithromycin/Azithromycin+Etm+/-
Rifampin
51. According to revised national TB control program [RNTCP]
Category of Treatment Type of Patient Regimen
Category I New sputum smear-positive
Seriously ill** new sputum
smear-negative Seriously
ill** new extra-pulmonary
2H3R3Z3E3+ 4H3R3
Category II Sputum smear-positive
Relapse Sputum smear-
positive Failure Sputum
smear-positive Treatment
After Default Others
2H3R3Z3E3S3 + 1H3R3Z3E3 +
5H3R3E3
Category III New Sputum smear-
negative, not seriously ill
New Extra-pulmonary, not
seriously ill
2H3R3Z3 + 4H3R3
52. STANDARD TREATMENT -First line
drugs
The recommended preferred first-line ARV regimens
For infants and children are:
Regimen of 2 NRTI plus 1 NNRTI
AZT* + 3TC + NVP or EFV**
D4T + 3TC + NVP or EFV**
ABC+ 3TC + NVP or EFV is an alternative however, in the
national programme – ABC is not available and is still costly.
53. HIV with TB
Anti TB should be started first & ART should be started 2-
8 weeks after anti TB for those individuals who have a CD4
count of less than 200mm.
Increased risk of inflammatory immune reconstitution
syndrome
Rifampicin lowers NVP drug level by 20-58% and EFV
drug level by 25%. In children, there is no information on
appropriate dosing of NVP and EFV when used with
Rifampicin.
2NRTI + NVP
54. PATIENT COUNSELLING
About disease : TB is a chronic granulomatous disease
caused by mycobacterium tuberculosis.
RVD : A disease in which there is severe loss of body
cellular immunity , grately lowering the resistance to
infection and malignancy .
About drug : Pantaprazole – taken half an hour before
meals
Benadon : taken with meals .
Cefotaxim : should Be taken after meals
INH+PYR+RIFAMPICIN – taken on empty stomach one
hour before meals.
55. LIFE STYLE MODIFICATION FOR RVD
WITH PTB
Medication Adherence
Potential adverse effects from and interactions with
antiretroviral drug therapy and ways to manage
adverse effects
Educating the patient about modes of HIV
transmission and effective techniques for prevention
of transmission
Nutritional assessment
Psychological support
Exercise
56. Dont spit in the public places
Avoid irritants (smoke , dust )
Use mask while coughing
About the administration of the drugs which the
doctor has prescribed
Advice patients to report the signs of hepatic
dysfunction such as dark urine , decreased appetite ,
jaundice .