Kawasaki disease is an acute febrile illness that primarily affects young children and infants, causing inflammation of blood vessels. It is characterized by fever, rash, swelling of hands and feet, irritation and redness of eyes, and swelling of lymph nodes in the neck. The cause is unknown but may be due to an immunological response to an infectious agent. Treatment involves intravenous immunoglobulin and aspirin to prevent complications like coronary artery aneurysms and abnormalities. Ongoing monitoring is needed as some patients are resistant to initial treatment or develop coronary artery issues later. Recent studies have found potential links between Kawasaki disease and COVID-19 infections in children.
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
Let's learn the pharmacology related to nephrotic syndrome - features of nephrotic syndrome with underlying mechanisms, objectives of treatment, and management of the nephrotic syndrome.
Multiple Organ Dysfunction Syndrome (MODS).Pinky Rathee
The presence of altered organ function in a client who is acutely ill such that hemeostasis cannot be maintained without intervention. MODS is present when two or more organs fail .MODS results from SIRS
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
Let's learn the pharmacology related to nephrotic syndrome - features of nephrotic syndrome with underlying mechanisms, objectives of treatment, and management of the nephrotic syndrome.
Multiple Organ Dysfunction Syndrome (MODS).Pinky Rathee
The presence of altered organ function in a client who is acutely ill such that hemeostasis cannot be maintained without intervention. MODS is present when two or more organs fail .MODS results from SIRS
Case presentation on SLE with Pleural effusion (Soap format)Dr. Sharad Chand
Case presentation on SLE with Pleural effusion ,with typical SOAP format, Pharmaceutical care plan, pharmacist intervention & Critical appraisal of the laboratory datas compared with standard reference values.
Interstitial lung diseases (ILDs) are a group of more than 200 different disorders that cause scarring in the lungs. Scar tissue in the lungs can make it harder for you to breathe normally. In ILDs, scarring damages tissues in or around the lungs’ air sacs and airways.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
Glomerulonephritis: History taking and examination.Ahmed Redwan
The history, and physical examination
aimed at :
Clinical differentiation of major nephrological syndromes.
Establishing possible cause(s).
Finding evidence of associated multisystem disease
Excluding confounding non-glomerular disease (e.g. urological)
Evaluation & grading renal function.
Estimate complication (s)
Report previous management to which the patient was subjected to and its outcome.
Case presentation on SLE with Pleural effusion (Soap format)Dr. Sharad Chand
Case presentation on SLE with Pleural effusion ,with typical SOAP format, Pharmaceutical care plan, pharmacist intervention & Critical appraisal of the laboratory datas compared with standard reference values.
Interstitial lung diseases (ILDs) are a group of more than 200 different disorders that cause scarring in the lungs. Scar tissue in the lungs can make it harder for you to breathe normally. In ILDs, scarring damages tissues in or around the lungs’ air sacs and airways.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
Glomerulonephritis: History taking and examination.Ahmed Redwan
The history, and physical examination
aimed at :
Clinical differentiation of major nephrological syndromes.
Establishing possible cause(s).
Finding evidence of associated multisystem disease
Excluding confounding non-glomerular disease (e.g. urological)
Evaluation & grading renal function.
Estimate complication (s)
Report previous management to which the patient was subjected to and its outcome.
CME Varicella-zoster Infection in Paediatric.pdfzackaim754
Paeds - Case Presentation of Chicken Pox :
A comprehensive presentation covering case study from symptomatic clinical presentation, lab study, diagnosis, therapies, disease etiology, virus reinfection, complications, etc. The setting of this case is in a General Hospital located in Peninsular Malaysia.
Since a lot of data were not available about this rare disease, we decided to gather and organize data for it in a presentation made with love.
other names for the disease :
Acute hemorrhagic edema of childhood.
Finkelstein's disease.
Infantile postinfectious iris-like purpura and edema.
Medallion-like purpura.
Purpura en cocarde avec oedema.
Seidlmayer syndrome.
Definition of hip fracture in elder population, risk factor, medical management.
and evaluating a journal club of article " Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults"
Complete definition of Hypoxic Ischemic Encephalopathy, clinical manifestations according to Sarnat staging system, risk factor, pathophysiology and details of management and approaches to be used.
Anticoagulation in Valvular Heart Disease.pptxzeinabnm
Brief definition with pathology, types, risk factors, clinical manifestation and staging in Valvular heart disease.
with detailed discussion of clinical management and approaches in different situation.
necessary information about each anti-coagulation used.
Brief definition, diagnosis, clinical manifestations of pelvic inflammatory disease with details of approach of management as a journal club evaluation
overview of types, differentiation and clinical manifestations of conjunctivitis along with appropriate medications used with brand names available in Lebanon.
Journal Club evaluation, effect of Rivaroxaban in heart failure
background of heart failure, pathophysiology, epidemiology and the treatment algorithm.
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.
- 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
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
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.
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
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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!
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
2. TOMISAKU KAWASAKI
Tomisaku Kawasaki was a Japanese pediatrician who first described the condition now known as
Kawasaki disease in the 1960s.
2 https://en.wikipedia.org/wiki/Tomisaku_Kawasaki
3. OUTLINE
At the end of the presentation we’ll be able to:
Recall the pathophysiology, diagnosis, symptoms, epidemiology of
Kawasaki Disease.
Identify the classification and pharmacological treatment modalities
Learn the different drugs used
3
4. DEFINITION OF KAWASAKI DISEASE
• Kawasaki disease (KD), formerly known as Mucocutaneous Lymph Node
Syndrome and Infantile Polyarteritis Nodosa
• It’s an acute febrile illness characterized by inflammation of blood vessels
(Vasculitis) throughout the body that primarily affects young children and
infants.
• It’s considered to be the leading cause of acquired heart disease in children
worldwide.
4 https://pubmed.ncbi.nlm.nih.gov/28356445/
5. EPIDEMIOLOGY
80% of cases in children < 4 years
Male : Female = 2:1
Highest incidence occurring in East
Asian (Japan, Taiwan, Korea) children.
Positive family history in 1% but 13%
risk of occurrence in twins.
Infants <6 months and children >5
years are at the highest risk of CAA.
One-fourth of adult KD cases have
occurred in patients with human
immunodeficiency virus (HIV)
infection.
Seasonal variation- More cases in
winter and spring but occurs
throughout the year.
5 https://www.cdc.gov/kawasaki/about.html#
8. PATHOPHYSIOLOGY
• The etiology of KD remains unknown. A variety of theories have been
proposed based upon pathologic, epidemiologic, and demographic data.
• Theories:
8
Immunologic
response
Infectious
etiology
Genetic
factors
Multisystem
inflammatory
syndrome
https://emedicine.medscape.com
9. PATHOPHYSIOLOGY
Immunologic Response:
affects medium-sized arteries, especially the coronary arteries.
The unknown stimulus cause the inflammatory cell infiltration into vascular tissues
vascular damage.
The destruction of elastin and collagen fibers and loss of structural integrity of the
arterial wall lead to dilatation and aneurysm formation.
Inflammatory cells are:
• Neutrophils
• T cells = CD 8
• Eosinophil
• Plasma cell = Ig A
9 https://www.nature.com.
10. PATHOPHYSIOLOGY
Infectious etiology:
KD is caused or triggered by a transmissible agent or agents.
Similar clinical presentation to Adenovirus, Measles and Scarlet fever.
No studies have convincingly identified a specific virus, bacteria or bacterial toxin, or
other pathogen associated with KD.
10 https://www.nature.com.
11. PATHOPHYSIOLOGY
Multisystem inflammatory syndrome:
Coronavirus disease 2019 (COVID-19) is associated with hyper inflammatory syndromes.
Children may develop organ failure involving the gastrointestinal tract, heart, central
nervous system, kidneys, and other systems.
The severe inflammation, cytopenias, coagulopathy, and hyper ferritinemia are similar to
macrophage activation syndrome or toxic shock in some children.
11 https://www.nature.com.
12. PATHOPHYSIOLOGY
Genetic factors:
Increase frequency of the disease in Asian and Asian-American populations and among
family members.
Variants or polymorphisms that are associated with an increased susceptibility to KD:
• Inositol 1,4,5-trisphosphate 3-kinase C (ITPKC) gene on chromosome 19q13.2. ITPKC acts as a
negative regulator of T cell activation which act more vigorously than normal.
• Upregulation of Angiopoietin 1 (ANGPT1)
• Downregulation of Vascular endothelial growth factor A (VEGFA) genes
• The genes encoding the chemokine receptor CCR5 and its major ligand CCL3L1
• ATP binding cassette, subfamily C, member 4 (ABCC4) gene
12 https://www.nature.com.
13. CLINICAL MANIFISTASTIONS
Fever
• Most consistence manifestation
• Above 38.5 ºC during most of the illness
Conjunctivitis
• Bilateral non-exudative conjunctivitis is present in more than 90
percent of patients.
Lymphadenopathy
• Primarily involve the anterior cervical nodes overlying the
sternocleidomastoid muscles
• >1.5 cm in diameter
13
14. CLINICAL MANIFISTASTIONS
MUCOSITIS
Often becomes evident as KD progresses.
Cracked, red lips and a "strawberry
tongue"
RASH
Polymorphous
Begins during the first few days of illness.
Perineal erythema and desquamation,
followed by macular, morbilliform, or targetoid
skin lesions of the trunk and extremities.
EXTREMITIES CHANGES
Last manifestation to appear
Indurated edema of the dorsum of their
hands and feet
Desquamation that begins in the
periungual region of the hands and feet
CARDIOVASCULAR
First week to 10 days of illness
Tachycardia, Muffle sound, Fusiform
aneurysms
Infants may have cold, pale, or cyanotic
digits of the hands and feet due to reduced
perfusion
14 https://www.mayoclinic.org/diseases-conditions/kawasaki-disease/diagnosis-treatment/drc-20354603
19. 19
Patient diagnosed with Kawasaki Disease
Asses patient’s risk for IVIG risk
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000484
For Japanese patient: use the KOBAYASHI criteria (≥5 consider high risk)
Sodium ≤ 133 mmol/L (2 POINTS)
Aspartate aminotransferase ≥ 100 IU/L (2POINTS)
CRP ≥ 10 mg/dL (1 POINT)
Neutrophils ≥ 80% of the WBC-D (2 POINTS)
Platelet count ≤ 300,000/mm3 (1 POINT)
Days of illness at initial treatment ≤ 4 (2 POINTS)
Age ≤ 12 months (1 POINT)
For non-Japanese patient: (≥3 considered high risk)
Enlarged CAs on echocardiogram with maximum Z-score at baseline ≥2.00 (2 POINTS)
Age at fever onset < 6 months (1 POINT)
Any Asian race reported (1 POINT)
CRP > 13 mg/Dl (1 point)
20. Patient diagnosed with Kawasaki Disease
Asses patient’s risk for IVIG risk
Low Risk High Risk
Standard initial therapy: Combination
• IVIG: 2g/kg × 1 dose over 8-12 hours
• Aspirin: initially 30-50 mg/kg/day OR 80-100
mg/kg/day orally in 4 divided dose.
Maximum: 4 g/day
Decrease dose to 3-5 mg/kg/day 48 hours after
resolution of fever
Stop after normalize of ESR unless CA
abnormalities detected
Adjunctive initial therapy: all of 3 agents
• IVIG: 2g/kg × 1 dose over 8-12 hours
• Aspirin: initially 30-50 mg/kg/day orally in 4 divided
dose.
Maximum dose: 4 g/day
• Prednisone/ Prednisolone: 2mg/kg/day IV/PO in
two divided doses for 10 days (max dose: 60mg), then
1 mg/kg/day for 5 days.
• Etanercept: further studies needed
20 https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000484
21. 21
Agents MOA SE
IVIG (Gammagard®)
Offer passive immunity by
increasing antibody titer and
antigen-antibody reaction potential
Acute renal dysfunction and renal failure
Headache, Fatigue, N/V, Chills
Aspirin
Inhibit synthesis of prostaglandin by
cyclooxygenase, Antiplatelet
Bronchospasm, GI pain, Hearing loss
Reye syndrome
Prednisone
Glucocorticosteroid, anti-
inflammatory
Sodium water retention, Osteoporosis
Skin atrophy, Weight gain
Etanercept (Enbrel®) Bind and inactivates TNF
URTI, Injection site reaction, Diarrhea
and Rash
All children ≥6 months should receive a seasonal influenza vaccine, as should their family members.
Only inactivated vaccine should be administered to children on aspirin therapy.
Concomitant use of ibuprofen antagonizes the irreversible platelet inhibition induced by ASA. thus,
ibuprofen generally should be avoided in children with coronary artery aneurysms taking ASA for its
antiplatelet effects.
https://www.medscape.com
https://www.ahajournals.org
22. 22
IVIG RESISTANCE
Approximately 10% to 20% of patients with KD have
persistent or recurrent fever at least for 36 hours after end
of primary therapy with IVIG plus ASA.
Many studies have shown that patients who are resistant
to initial IVIG are at increased risk of developing Coronary
Artery Abnormalities.
It is likely that host genetic factors, such as polymorphisms
in the Fc gamma receptors, play a role in both the
response and resistance to IVIG.
https://www.nhlbi.nih.gov
26. 26
• There has been apparent cluster of children
presenting with Kawasaki disease (KD)-like
symptoms in United Kingdom, United States
and Italy.
• Some of these children patients have
confirmed SARS-CoV-2 infections by RT-PCR.
• The relationship of KD to COVID-19 is not
yet defined, there is growing concern of
SARS-CoV-2 infection related inflammatory
syndrome as a possible link between
coronavirus infection and KD affecting
young children.
• SARS-CoV-2 infection and hyper
inflammation in COVID-19 could be acting as
the "priming trigger" that could lead to KD.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247462/
27. • COVID-19 cases of children in the UK, US and
Italy show KD-like symptoms which sparks
concern about a possible link to COVID-19, as
both disease show similar signs of fever. KD
causes vascular inflammation and restricts
blood flow to the heart.
• Patients with KD and tested positive for
COVID-19 have 25% higher risk for Coronary
Artery Aneurysm (CAA).
• Therefore, KD patients should be closely
monitored for potential COVID-19 infection
and quarantined after IVIG infusion and
patient discharge if tested positive for SARS-
CoV-2 infection.
• It is important to administer IVIG within 7
days since disease onset till KD symptoms
gone and COVID-19 test negative.
• Further studies needed to define mechanistic
link between COVID-19 and KD.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247462/
27
Editor's Notes
Vaccines are required annually before incidence of Kawasaki Disease other wise its contraindicated if patient is receiving IVIG for 11 months.