This document discusses protein energy malnutrition (PEM), including its causes, types, assessment, and treatment. PEM is caused by inadequate intake of protein and calories and is highly prevalent in developing countries, contributing to over 50% of deaths in children under 5. The two main types of PEM are kwashiorkor, characterized by edema, and marasmus, characterized by wasting. PEM is assessed through clinical exam, anthropometry, dietary assessment, and laboratory tests. Treatment involves rehydration, dietary supplementation, infection treatment, and prevention of complications. PEM has severe health impacts and early detection and management are important for recovery.
MALNUTRITION is more in India than in Africa . one in every three malnourished children in the world lives in India.
About 50% of all childhood death are because of malnutrition.
MALNUTRITION is more in India than in Africa . one in every three malnourished children in the world lives in India.
About 50% of all childhood death are because of malnutrition.
Management of Severe Acute Malnutrition.pptxEfosa Aimien
Severe acute malnutrition is a standard term referred to a condition where a child has severe wasting and/or bilateral pedal edema.
The health, social and economic burden of this condition cannot be overemphasised. It is needful and timely yet again to reiterate and summarily but comprehensively outline the management of this condition. Thus, this presentation is a comprehensive summary of the management of severe acute malnutrition as outlined in standard paediatric textbooks.
A detailed explanation should however be sourced from standard texts and updated journals.
This presentation is cannot be cited or referenced in publications, presentations nor public fora.
The presenters:
Dr Efosa Emmanuel Aimien is a Paediatric Resident on outside posting at the National Hospital Abuja. He had his medical training at the prestigious College of Health Sciences, Ahmadu Bello Univeristy, Zaria. Nigeria.
Dr Zarah Fatima Abdu is a Paediatric Senior Resident at the Department of Paediatrics, National Hospital Abuja. Her vastness and clinical acumen in child health especially malnutrition is without question.
We hope this presentation contributes to the ease of gaining medical knowledge especially in Paediatrics.
Thank you.
It is important topic which needs to be understand by students and i am using for teaching to VI semester mbbs students. i think it will give a brief idea about protein energy malnutrition.
- 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
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.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
2. HUMAN NUTRITION
Nutrients are substances that are
crucial for human life, growth &
well-being.
Macronutrients (carbohydrates,
lipids, proteins & water) are
needed for energy and cell
multiplication & repair.
Micronutrients are trace elements &
vitamins, which are essential for
metabolic processes.
3. HUMAN NUTRITION/2
Obesity & under-nutrition are the 2
ends of the spectrum of
malnutrition.
A healthy diet provides a balanced
nutrients that satisfy the metabolic
needs of the body without excess
or shortage.
Dietary requirements of children
vary according to age, sex &
4. Assessment of Nutr status
Direct
Clinical
Anthropometric
Dietary
Laboratory
Indirect
Health statistics
Ecological variables
5. Clinical Assessment
Useful in severe forms of PEM
Based on thorough physical
examination for features of PEM &
vitamin deficiencies.
Focuses on skin, eye, hair, mouth &
bones.
Chronic illnesses & goiter to be
excluded
7. ANTHROPOMETRY
Objective with high specificity &
sensitivity
Measuring Ht, Wt, MAC, HC, skin
fold thickness, waist & hip ratio &
BMI
Reading are numerical & gradable
on standard growth charts
Non-expensive & need minimal
training
10. DIETARY ASSESSMENT
Breast & complementary feeding
details
24 hr dietary recall
Home visits
Calculation of protein & Calorie
content of children foods.
Feeding technique & food habits
11.
12. OVERVIEW OF PEM
The majority of world’s children live
in developing countries
Lack of food & clean water, poor
sanitation, infection & social unrest
lead to LBW & PEM
Malnutrition is implicated in >50%
of deaths of <5 children (5
million/yr)
13. CHILD MORTALITY
The major contributing factors are:
Diarrhea
20%
ARI
20%
Perinatal causes
18%
Measles
07%
Malaria
05%
55% of the total have malnutrition
14.
15. EPIDEMIOLOGY
The term protein energy
malnutrition has been adopted by
WHO in 1976.
Highly prevalent in developing
countries among <5 children;
severe forms 1-10% & underweight
20-40%.
All children with PEM have
micronutrient deficiency.
16.
17. PEM
In 2000 WHO estimated that 32% of
<5 children in developing countries
are underweight (182 million).
78% of these children live in Southeast Asia & 15% in Sub-Saharan
Africa.
The reciprocal interaction between
PEM & infection is the major cause
of death & morbidity in young
children.
18.
19.
20.
21. PEM in Sub-Saharan Africa
PEM in Africa is related to:
The high birth rate
Subsistence farming
Overused soil, draught &
desertification
Pets & diseases destroy crops
Poverty
Low protein diet
Political instability (war &
displacement)
22. PRECIPITATING FACTORS
• LACK OF FOOD (famine, poverty)
• INADEQUATE BREAST FEEDING
• WRONG
CONCEPTS
ABOUT
NUTRITION
• DIARRHOEA & MALABSORPTION
• INFECTIONS (worms, measles, T.B)
23. CLASSIFICATION
A. CLINICAL ( WELLCOME )
Parameter: weight for age + oedema
Reference tandard (50th percentile)
Grades:
80-60 % without oedema is under weig ht
80-60% with oedema is Kwashiorkor
< 60 % with oedema is Marasmus-Kwash
< 60 % without oedema is Marasmus
24. CLASSIFICATION (2)
B. COMMUNITY (GOMEZ)
Parameter: weight for age
Reference standard (50th
percentile) WHO chart
Grades:
I
(Mild)
:
II (Moderate):
III (Severe) :
90-70
70-60
< 60
26. DISADVANTAGES
• AGE MAY NOT BE KNOWN
• HEIGHT NOT CONSIDERED
• CROSS SECTIONAL
• CAN’T TELL ABOUT
CHRONICITY
• WHO STANDARDS MAY NOT
REPRESENT LOCAL
COMMUNITY STANDARD
27. KWASHIORKOR
Cecilly Williams, a British nurse,
had introduced the word
Kwashiorkor to the medical
literature in 1933. The word is
taken from the Ga language in
Ghana & used to describe the
sickness of weaning .
28. ETIOLOGY
Kwashiorkor can occur in infancy
but its maximal incidence is in the
2nd yr of life following abrupt
weaning.
Kwashiorkor is not only dietary in
origin. Infective, psycho-socical,
and cultural factors are also
29. ETIOLOGY (2)
Kwashiorkor is an example of lack of
physiological adaptation to
unbalanced deficiency where the
body utilized proteins and conserve
S/C fat.
One theory says Kwash is a result of
liver insult with hypoproteinemia and
oedema. Food toxins like aflatoxins
have been suggested as
precipitating factors.
30. CLINICAL
PRESENTATION
Kwash is characterized by certain
constant features in addition to a
variable spectrum of symptoms and
signs.
Clinical presentation is affected by:
• The degree of deficiency
• The duration of deficiency
• The speed of onset
• The age at onset
• Presence of conditioning factors
• Genetic factors
31. CONSTANT FEATURES OF KWASH
OEDEMA
PSYCHOMOTOR CHANGES
GROWTH RETARDATION
MUSCLE WASTING
36. MARASMUS
The term marasmus is derived from
the Greek marasmos, which means
wasting.
Marasmus involves inadequate
intake of protein and calories and
is characterized by emaciation.
Marasmus represents the end
result of starvation where both
proteins and calories are deficient.
37. MARASMUS/2
Marasmus represents an adaptive
response to starvation, whereas
kwashiorkor represents a
maladaptive response to starvation
In Marasmus the body utilizes all
fat stores before using muscles.
38. EPIDEMIOLOGY &
ETIOLOGY
Seen most commonly in the first
year of life due to lack of breast
feeding and the use of dilute animal
milk.
Poverty or famine and diarrhoea
are the usual precipitating factors
Ignorance & poor maternal nutrition
are also contributory
39. Clinical Features of Marasmus
Severe wasting of muscle & s/c fats
Severe growth retardation
Child looks older than his age
No edema or hair changes
Alert but miserable
Hungry
Diarrhoea & Dehydration
40.
41.
42. CLINICAL ASSESSMENT
Interrogation & physical exam
including detailed dietary history.
Anthropometric measurements
Team approach with involvement of
dieticians, social workers &
community support groups.
43. Investigations for PEM
Full blood counts
Blood glucose profile
Septic screening
Stool & urine for parasites & germs
Electrolytes, Ca, Ph & ALP, serum
proteins
CXR & Mantoux test
Exclude HIV & malabsorption
46. TREATMENT
Correction of water & electrolyte
imbalance
Treat infection & worm infestations
Dietary support: 3-4 g protein & 200 Cal
/kg body wt/day + vitamins & minerals
Prevention of hypothermia
Counsel parents & plan future care
including immunization & diet
supplements
47. KEY POINT FEEDING
Continue breast feeding
Add frequent small feeds
Use liquid diet
Give vitamin A & folic acid on
admission
With diarrhea use lactose-free or
soya bean formula
48. PROGNOSIS
Kwash & Marasmus-Kwash have
greater risk of morbidity & mortality
compared to Marasmus and under
weight
Early detection & adequate
treatment are associated with good
outcome
Late ill-effects on IQ, behavior &
cognitive functions are doubtful and