Meningitis is an inflammation of the meninges that can cause significant morbidity and mortality, especially in children. The most common causes are bacterial and include Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis. Symptoms vary by age but may include fever, headache, nausea, and neck stiffness. Lumbar puncture and CSF analysis are important for diagnosis. Empiric antibiotic therapy should cover the most common pathogens. Complications can include neurological deficits, hearing loss, seizures, and hydrocephalus. Prevention through immunization against preventable causes such as Hib, meningococcus, and pneumococcus can reduce the burden of disease.
Please find the power point on Meningoencephalitis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Meningoencephalitis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Now a days TBM is super most disease in Indian children.
Tuberculous meningitis (TBM) is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis.
Clinical Approach To Aseptic Meningitis and Encephalitis
Virology Rotation (R2) , Clinical Microbiology Residency
King Fahd Hospital of The University
23/4/2019
Now a days TBM is super most disease in Indian children.
Tuberculous meningitis (TBM) is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis.
Clinical Approach To Aseptic Meningitis and Encephalitis
Virology Rotation (R2) , Clinical Microbiology Residency
King Fahd Hospital of The University
23/4/2019
Syncope (nx power lite) /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
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
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
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.
2. • Definition:
- Inflammation of the leptomeninges
• Importance:
- Significant cause of morbidity and mortality among
children. 426,000 children are affected annually, with
85,000 deaths.
Overall mortality rate is 5 – 10%: 15 – 20% in
neonates, 3 -10% in older children.
Mortality rate from S.pneumoniae is 26.3 – 30%, H.
influenza type B is 7.7 – 10.3, N. meningitidis is 3.5 –
10.3%
3. - High frequency of neurologic sequelae: up to
30%, highest with S pneumonia.
- Classical symptoms and signs may not be
present in neonates and infants
- The most important causes are preventable
through immunisation (S. pneumonia, Hib, N.
meningitidis, Mtb, and some viral causes e.g
Measles, Rubella)
4. Aetiology
• Bacterial:
a) 0 - 2 months
- Escherichia coli
- Group B streptococci
- Listeria monocytogenes
- Others: Klebsiella, Salmonella
b) 2 months – 2 years
- Streptococcus pneumoniae
- Haemophilus influenza type b
- Neisseria meningitidis
5. c) 3 years and above
- S. pneumonia
- N. meningitis
- Hib
- Mycobacterium tuberculosis
d) Unusual bacteria
- Staphylococcus aureus
- Pasteurella multocida
- Mycoplasma
7. Predisposing/ Risk factors
• Age: prematures, neonates
• Intrauterine infection
• Maternal infection and pyrexia at delivery
• Open head trauma (with skull fracture or CSF leakage)
• Contiguous focus of infection e.g. sinusitis, otitis media,
mastoiditis, osteomyelitis of skull, periorbital and facial cellulitis,
septic arthritis,
• Open neural tube defects
• Neurosurgical procedures and patients with ventriculoperitoneal
shunts
• Immune deficiency (primary or secondary)
• Sickle cell anaemia or asplenia
• Overcrowding
• Immunisation status
8. Pathogenesis
• Acquisition:
Aerosol or droplet, nasopharyngeal
colonisation, replication and invasion
• Spread:
- Haematogenous: from nasopharynx, skin, or
following pneumonia, infective endocarditis;
bacteremia then meningeal seeding
- Direct: Otitis media, mastoiditis, sinusitis,
open head injury
10. Clinical features
• History: Brief & fulminant Vs slow gradual
a) Bacterial meningitis:
Neonate:
- Maternal infection or pyrexia at delivery
- Non specific symptoms: change in feeding or
sleeping habits, irritability, lethargy, vomiting,
high pitched cry, seizures, paradoxical
irritability (quiet at rest, cries when moved or
comforted)
Infants:
- Fever, lethargy, irritability, change in
11. After 2 - 3 years:
- Headache, irritability, nausea, vomiting,
anorexia, nuchal rigidity, photophobia,
confusion, back pain, seizures, coma
b) Viral:
- Onset variable; fever, general malaise,
anorexia, vomiting
- features of pharyngitis, conjunctivitis, myositis
- seizures and evidence of encephalitis
12. c) Tuberculous meningitis
- occurs 3 – 6 months following primary
infection
- sudden or insiduous presentation
- 3 stages:
- First stage: 1 -2 weeks of fever, headache,
malaise, irritability
- Second stage: typical meningeal signs
- Third stage: worsening neurological
condition, coma and death
d) Fungal meningitis:
- Immunesuppressed patients, variable
presentation
13. Physical Examination
• Young infant:
- Irritable, unconscious
- Febrile, hypothermic
- Bulging fontanelle
- Diastasis of the sutures
- +/- Nuchal rigidity
• Older child:
- Meningeal signs: Neck stiffness, +ve Kernig
and Brudzinski signs,
14. - Bulging fontanelle
- Ptosis, Sixth nerve palsy, diplopia
- Bradycardia, hypertension and apnea =
Cushing’s triad – brain herniation
- Focal neurological signs in 15% of patients
- Seizures in up to 30% patients
- Altered consciousness and coma 15 – 20%
15. Signs and Symptoms of Bacterial MeningitisSigns and Symptoms of Bacterial Meningitis
Hemi paresis, ptosis,
deafness, facial nerve palsy,
optic neuritis
Hemiparesis, ptosis, facial
nerve palsy
FocalFocal
neurologicneurologic
signssigns
Headache, bulging fontanel,
diastasis of sutures in infants,
papilledema, mental
confusion, altered state of
consciousness
Bulging fontanel, diastasis of
sutures, convulsions,
opisthotonus
IncreasedIncreased
intracranialintracranial
pressurepressure
Neck rigidity, Kernig and
Brudzinski sign
Neck rigidity,MeningealMeningeal
inflammationinflammation
Fever, anorexia, confusion,
irritability, photophobia,
nausea, vomiting, headache,
seizure
Fever or hypothermia,
abnormally sleepy or lethargic,
disinterest in feeding, poor
feeding, cyanosis, grunting,
apneic episodes, vomiting
NonspecificNonspecific
Older infants and childrenOlder infants and childrenNeonatesNeonatesSigns andSigns and
symptomssymptoms
17. • CSF examination:
- Most important
- Lumbar puncture: anatomical markings,
opening and closing pressures
- Analysis:
- Cell counts; total and differential,
- Gram stain (
- ZN stain
- Indian ink stain
- Glucose
- Protein
- Antigen tests
- Culture and sensitivity (even with ‘normal csf’)
18. - Latex agglutination tests
• Contraindications to LP:
- Infection at LP site
- Signs of increased ICP (other than a bulging
fontanelle)
- Suspicion of a mass lesion
- Extreme patient instability
CSF findings in various conditions are attached;
Interpretation of CSF from a traumatic LP
19. • Imaging studies:
- Rarely required
- May be needed to rule out other pathology
before LP, or when focal nerological signs are
present
- Helpful in abscesses, subdural effusions,
empyema, hydrocephalus
- CT Scan, MRI: Normal findings do not rule out
increased ICP
- Cranial Ultrasound Scan
21. Management
• Airway, Breathing, Circulation
• Management of seizures
• Empiric and specific antibiotic therapy
• Supportive treatment
- ABC
- Fluid: 2/3 of maintenance
- Feeding
- Antipyretics
- Physiotherapy, occupational therapy
- Counseling and support to attendants
22. Empiric Therapy for BacterialEmpiric Therapy for Bacterial
MeningitisMeningitis
Bacterial meningitis is a medical emergency,
delay in treatment may lead to increased
sequelae or death
Drug of choice must be bactericidal for pathogen
involved
Must achieve adequate levels in the CSF
Initial regimen should cover most likely
pathogens for specific age groups, and reach
bactericidal levels in the CSF
Knowledge of local susceptibility patterns is
essential
23. Empiric Therapy for Bacterial MeningitisEmpiric Therapy for Bacterial Meningitis
Cefotaxime or
Chloramphenicol
Benzyl penicillin
&
Ceftriaxone
H. influenzae
S. pneumoniae
N. meningitidis
2mos – 5 yrs
Chloramphenicol
Or Ceftriaxone
Penicillin GS. pneumoniae
N. meningitidis
>5 yrs
Ampicillin +
Cefotaxime or
Ceftriaxone
Ampicillin or
Penicillin +
Aminoglycoside
E. coli
Gram (-) bacilli
S. pneumoniae
0-2 mos
AlternativePrimary
Antimicrobial choiceLikely etiologyPatient
group
24. Duration of Therapy of
Bacterial Meningitis*
Pathogen Suggested duration
of therapy (days)
H. influenzae 10-14
S. pneumoniae 10 -14
N. meningitidis 10 - 14
Grp. B. streptococci 14-21
G(-) bacilli 21
*Quagliarello, et al, NEJM 1997, 336(10):708-716
25. Supportive management
IV Fluids and hydration
maintain normal blood pressure, watch out
for SIADH
Control of increased intracranial pressure
Nutritional support
Prevention- chemoprophylaxis,
immunizations, infection control
27. Persistent fever
• Inadequate drug doses
• Organism not sensitive to drug
• Drug fever
• Complications: cerebral abscess, ventriculitis,
subdural effusion
• Another focus of infection
• Hib infection
• Pericardial or joint effusions
28. Poor prognosis
• Young age: Prematures, neonates
• Long duration of illness prior to effective
antibiotic therapy
• Late onset seizures
• Coma and other coplications at presentation
• Shock
• Low or absent CSF WBC count in the presence
of visible bacteria on CSF Gram stain
• Immunocompromised status
• Positive CSF culture
• Organism: Strep pneumoniae
29. Look out for:
• Role of immunisation in the prevention and
control of meningitis
• Role of steroids in the management of
meningitis
• TB and fungal meningitis