This document provides information on infective endocarditis (IE), including:
- Definitions, classifications, risk factors and causative organisms of IE.
- The pathogenesis and clinical manifestations of IE.
- Diagnostic criteria including the Duke Criteria and imaging/laboratory tests.
- Antibiotic regimens and management considerations including monitoring, empirical therapy, and indications for surgery.
- Prevention through prophylactic antibiotic regimens for high-risk cardiac conditions.
- Outcome factors that impact prognosis.
Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.
One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue. Even when acute coronary syndrome causes no cell death, the reduced blood flow changes how your heart works and is a sign of a high risk of heart attack.
Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment include improving blood flow, treating complications and preventing future problems.
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
A powerpoint presentation about infective Endocarditis, with the most recent updates from the most reliable sources. I highlighted an introduction, pathology, approach to disease & different management plans in this presentation. 2018. Please don't forget to give me credit to my work.
Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.
One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue. Even when acute coronary syndrome causes no cell death, the reduced blood flow changes how your heart works and is a sign of a high risk of heart attack.
Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment include improving blood flow, treating complications and preventing future problems.
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
A powerpoint presentation about infective Endocarditis, with the most recent updates from the most reliable sources. I highlighted an introduction, pathology, approach to disease & different management plans in this presentation. 2018. Please don't forget to give me credit to my work.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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. Guide By: Dr. Meenaxi Sharda
Presented By: Dr. Naresh Kumar Meghwal
(Resident GMC Kota)
2. DEFINITION
• Infection of the endocardial surface of
the heart, which may include heart
valves (native or Prosthetic) , the mural
endocardium , or septal defect.
• The prototypic lesion of IE is the
vegetation, is a mass of platelets, fibrin,
microcolonies of microorganism, and
scant inflammatory cells.
3. CLASSIFICATION
ACUTE ENDOCARDITIS
• Rapid damage of previously normal as well as diseased heart
valve, with a highly virulent organism
• Hematogenoulsy seeds to extracardiac sites
• If untreated, leads to death within weeks
SUBACUTE ENDOCARDITIS
• Organisms of low virulence causing infection in a previously
damaged heart, particularly on deformed valves.
• Raraly metastasizs
• Follow an indolent course of weeks to month
• Gradually progressive unless complicated by a major embolic
event or ruptured mycotic aneurysm
4. RISK FACTOR
• Intravenous drug abuse
• Artificial heart valves and pacemakers
• Cardiac conditions such as MR, AS, AR, MVP
and CHD
• Intravascular catheters ,Hemodialysis,
Nosocomial wound and UTI
5. CAUSATIVE ORGANISM
• Acute IE is caused by Beta-Hemolytic
streptococci, S. aureus, and Pneumococci.
• Subacute IE is typically caused by viridans
streptococci, enterococci, CoNS and HACEK
group (Haemophilus, Actinobacillus,
Cardiobacterium, Eikenella, and Kingella)
• Endocarditis amoung IV drug users caused by
S. aureus , P. aeruginosa and candida sp.
6. PATHOGENESIS
• Organism enter bloodstream from mucosal
surface, skin, and site of focal infection.
• Endothelial injury (at the site of impact of high
velocity blood jets or on low pressure side of
cardiac structrual lesion) causes turbulent
blood flow and
• allow either direct infection by virulent
organism or the development of an uninfected
platelet-fibrin thombus (NBTE).
7. Cont.
• Bactereamia – microorganism in blood adhere
to sites at thrombus . Organisms are
proliferate and induce a procoagulant state .
• Fibrin deposition combines with platelets
aggregation,stimulated by tissue factor and
independently by proliferating microorganism,
to generate an infected vegetation.
8. Endothelial injury
Un-infected platelet fibrin thrombus
(NBTE)
Transient bacteremia and
attachment of bacteria to NBTE
Proliferation and pro-coagulant state
Infected friable,bulky vegetation
9.
10. CLINICAL MANIFESTATION
Occur due to :
• Damage to intracardiac structures
• Embolization of vegetation fragments
• Hematogenous infection of sites during
bacteremia
• Tissue injury due to deposition circulating
immune complex
11. C0NSTITUTIONAL SYMPTOMS
• ACUTE IE:
• High grade fever and
chills
• SOB
• Arthralgias/ myalgias
• Abdominal pain
• Pleuritic chest pain
• Back pain
• SUBACUTE IE:
• Low grade fever
• Anorexia, N/V
• Weight loss
• Fatigue
• Arthralgias/ myalgias
• Abdominal pain
12. CARDIAC
• Murmur (85% cases) due to valvular damage
and ruptured chordae.
• CHF (40% cases) usually due to valvular
dysfunction.
• Perivalvular abscess.
• Pericarditis.
• Heart block.
• Myocardial infarction.
13. NONCARDIAC
• Nonspecific signs – petechiae, subungal or
“splinter” hemorrhages, clubbing,
splenomegaly, renal dysfunction, neurologic
symptoms.
• More specific signs - Osler’s Nodes, Janeway
lesions, and Roth Spots.
19. DIAGNOSIS
• Endocarditis should be suspected in patients with
fever and no obvious source of infection, and
particulary if heart murmur is present.
• Diagnosis of IE is established with certainty only
when vegetations obtained at cardiac surgery, at
autopsy, or from an artery (an embolus) are
examined histologically and microbiologically.
• A highly sensitive and diagnostic scheme is
known as DUKE CRITERIA has developed on basis
of clinical, laboratory and echo findings.
20. BLOOD CLUTURE
• If endocarditis is suspected, 3 blood culture sets,
separated from each other by atleast 1 hr. (20 mL
each), should be obtained from different
venipuncture sites within 24 hr.
• When endocarditis is present and no prior
antibiotic therapy was given, all 3 blood cultures
usually are positive because the bacteremia is
continuous; at least 1 culture is positive in 99%.
• Premature use of empiric antibiotic therapy
should be avoided in hemodynamically stable
patients to avoid culture-negative endocarditis.
21. DUKE CRITERIA
•Definite IE
o 2 major criteria OR
o 1 major and 3 minor criteria OR
o 5 minor criteria
•Possible IE
o 1 major and 1 minor criteria OR
o 3 minor criteria
•Rejected
o Firm alternate diagnosis OR
o Resolution of manifestations of IE with 4 days of antimicrobial therapy OR
o No pathologic evidence of IE at surgery or autopsy after 4 of antimicrobial
therapy.
22. MAJOR CRITERIA
Positive blood culture:
• Typical microorganism consistent with IE, from two separate
blood cultures
S. viridans, S. bovis, HACEK
community-acquired S. aureus or enterococci (no primary focus)
• Persistently positive cultures
at least two positive cultures, drawn 12 hours apart
all of three, or a majority of four or more cultures ,with first and
last sample drawn at least one hour apart
• Single positive blood culture for coxiella burnetii
Evidence of endocardial involvement:
• Positive echocardiogram
oscillating intracardiac mass on valve or supporting structures,
myocardial abscess,
new partial dehiscence of prosthetic valve
• New valvular regurgitation
23. MINOR CRITERIA
Predisposition
• Predisposing heart condition or IV drug abuser
Fever
• > 38.0º C
Vascular phenomena
• arterial emboli, septic pulmonary infarct, mycotic aneurysm,
intracranial hemorrhage, conjunctival hemorrhage, Janeway’s lesion
Immunologic phenomena
• glomerulonephritis, Osler’s nodes, Roth’s spots, rheumatoid factors
Microbiologic evidence
• positive blood culture but does not meet major criteria.
24. IMAGING
• Chest x-ray:
– Look for multiple focal infiltrates, calcification of
heart valves, evidence of cardiac failure and
cardiomegaly.
• ECG:
– Rarely diagnostic
– Look for evidence of ischemia, conduction
delay(AV block), and arrhythmias
• Echocardiography
25. ECHOCARDIOGRAPHY
• It allows anatomic confirmation of IE, size of
vegetations, detecting of intracardiac
complication, and assessment of cardic function.
• Trans thoracic echocardiography (TTE):
Noninvasive, First line if suspected IE, Native
valves IE, cannot image vegetation <2 mm in
diameter, sensitivity is 65%.
• Trans esophageal echocardiography (TEE): More
sensitive(>90%) than TTE , Prosthetic valves IE, or
detection of myocardial abscess, valve
perforation, intracardiac fistulae.
27. MANAGMENT
• Antibiotics remain the mainstay for treatment of IE.
• To cure endocarditis, all bacteria in vagetation must be killed;
therefore therapy must be bactericidal and prolonged.
• High dose antibiotics are administered parenterally, to
maximize diffusion of antibiotic molecules into depth of
vegetation.
• General measures include the following:
– Treatment of congestive heart failure
– Oxygen
– Hemodialysis (may be required in patients with renal failure).
• Surgery- Intracardiac complications
28. ANTIBOTIC REGIMEN FOR INFECTIVE ENDOCARDITIS:
STREPTOCOCCI
• Penicillin-susceptible:
– Penicillin G 2-3 mU IV 4 hourly for 4 weeks
– Ceftriaxone at 2 g/d IV as a single dose for 4
weeks
– Penicillin G or ceftriaxone (as above dose)
PLUS gentamicin at 1 mg/kg 8 hourly for 2
weeks;
– Vancomycin 15mg/kg IV 12 hourly for 4
weeks.
29. Cont.
• Relatively penicillin resistant streptococci
– Penicillin G or Ceftriaxone PLUS gentamicin 1
mg/kg IM or IV 8 hourly for 4 weeks
– Vancomycin 15mg/kg IV 12 hourly for 4 week.
• Moderately penicillin resistant streptococci
and nutritionally variant organisms
-Penicillin G (4-5 mU IV 4 hourly) or Ceftriaxone
(2 g/d IV) for 6 weeks PLUS gentamicin 1
mg/kg IM or IV 8 hourly for 4 weeks
-Vancomycin 15mg/kg IV 12 hourly for 4 week
30. Cont.
ENTEROCOCCI
• Penicillin G (4-5 mU IV 4 h) PLUS gentamicin (1
mg/kg IM or IV 8 h) for 4-6 weeks
• Ampicillin (2 g IV 4 h) PLUS gentamicin (1
mg/kg IM or IV 8 h) for 4-6 weeks
• Vancomycin (15 mg/kg IV 12h)PLUS
gentamicin (1 mg/kg IM or IV 8 h) for 4-6
weeks.
31. STAPHYLOCOCCI
Methicillin-sensitive S aureus:
• Nafcillin or oxacillin 2 g IV 4 h for 4-6 weeks
• Cefazolin 2 g IV 8 h for 4-6 weeks
• Vancomycin 15 mg/kg IV 12 h for 4-6 weeks
Methicillin-resistant S aureus:
• Vancomycin (15 mg/kg IV 12h for 6-8 weeks)
PLUS gentamicin (1 mg/kg IM or IV 8 h for 2
weeks).
• For infecting prosthetic valves (S/R) add rifampin
300 mg oral 8 h for 6-8 weeks.
HACEK Organisms
• Ceftriaxone 2 g/d IV as a single dose for 4 week
32. EMPIRICAL THERAPY
• In injection drug user should cover MRSA and gram
negative bacilli. The initiation of T/t with vancomycin
and gentamycin immediatly after blood is obtain for
cultures.
• Pending the availability of diagnostic data, blood
culture negative subacute NVE is T/t with ceftriaxone
plus gentamycin.
• If prosthetic valve are involved then above two plus
vancomycin should be used.
33. MONITORING
• Blood culture repeated daily until sterile.
• Blood culture become sterile within 2 days after
start of appropriate therapy when infection caused
by viridans streptococci, enterococci,or HACEK
organism.
• In S. aureus ,penicillin therapy results in 3-5 days,
whereas with vancomycin therapy culture positive
persist for 7-9 days.
• Resolution of fever within 5-7 days, when fever
persists for 7 days , patients should be evaluated for
paravalvular abscess and for extracardiac abscess
(spleen, kidney) or complications (embolic events ).
34. INDICATIONS FOR SURGERY
• Congestive heart failure refractory to standard medical
therapy
• Partially dehiscence unstable prosthetic valve
• Persistent sepsis despite appropriate antibiotic
treatment
• Lack of effective microbicidal therapy (eg. Fungal or
brucella)
• Relapse after optimal antimicrobial therapy
• Paravalvular abscess and intracardiac fistula
• Large(>10mm) hypermobile vegetations with increased
risk of embolism
• Persistent fever (>10 day) in culture negative NVE.
35. PREVENTION
High risk cardiac lesion for which prophylaxis is advised:
• Prosthetic heart valves
• Previous infective endocarditis
• Unrepaired cyanotic CHD (including palliative shunts and
conduits),
• Completely repaired CHD during the 1st 6 months after
surgery if prosthetic material or device was used
• Incompletely repaired CHD that has residual defects at or
adjacent to the site of repair
• Valvulopathy developing after cardiac transplantation
• Any procedure involving manipulation of gingival tissue or
the periapical region of teeth, or perforation of the oral
mucosa
36. REGIMEN FOR IE PROPHYLAXIS
Standard oral regime:
• Amoxicillin 2 g 1hr before procedure
Inability to take oral medication:
• Ampicillin 2g IV or IM 1hr before procedure
Penicillin allergy:
• Clindamycin 600 mg oral 1hr before procedure
• Clarithromycin or azithromycin 500 mg oral 1hr before
procedure
• Cephalexin 2 g oral 1hr before procedure
Penicillin allergy, inability to take oral:
• Cefazolin or Ceftriaxone 1g IV or IM 30 min before
• Clindamycin 600mg IV or IM 1hr before procedure
Regimen for IE prophylaxis
37. OUTCOME
• Older age, severe comorbid conditions, delayed
diagnosis, involvment of prosthetic or aortic
valve, an invasive(s.aureus) or antibiotic resistant
(P. aeruginosa, yeast)pathogen, intracardiac
complications, and major neurologic
complications adversely impact outcome.
• Prosthetic valve endocarditis beginning within 2
month of valve replacement results in mortality
rate of 40-50% , whereas rate are only10-20% in
later onset cases.