National guidelines on Pediatric TB in India were updated in 2012 to reflect recent evidence and advances. Diagnosis relies on demonstrating bacteriological evidence through alternative specimens like gastric lavage if sputum is unavailable. A positive tuberculin skin test of ≥10mm or symptoms like weight loss and cough for over 2 weeks also indicate TB. Treatment regimens include intermittent or daily therapy depending on severity, with adjusted doses based on weight. Preventive therapy of 6 months of INH is recommended for young contacts of active cases.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
contains about the introduction , causative agents , transmission , clinical features , diagnosis , management and guidelines in Nepal , breaking the chain of transmission
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
contains about the introduction , causative agents , transmission , clinical features , diagnosis , management and guidelines in Nepal , breaking the chain of transmission
RECENT ADVANCES IN DIAGNOSIS OF TUBERCULOSISANGAN KARMAKAR
TRADITIONAL TESTS AND RECENT DIAGNOSTIC MODALITIES FOR TUBERCULOSIS WITH EMPHASIS TO MOLECULAR DETECTION TECHNIQUES, DRUG SENSITIVITY ASSESMENT IN INDIAN PERSPECTIVE
Pulmonary tuberculosis
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs.
New treatment regimen is mentioned here.
Pharmacotherapy Of Tuberculosis infection.pptxdrsriram2001
Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also affect other parts of the body, such as the brain, kidneys, or spine. Here's a four-step explanation of tuberculosis:
Cause and Transmission: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. When an infected person with active TB coughs, sneezes, or talks, they release droplets containing the bacteria into the air. Another person can become infected by inhaling these droplets. TB is primarily transmitted through the air, making close and prolonged contact with an infected individual the main risk factor for transmission.
Symptoms: TB can manifest differently depending on whether it's active or latent. Latent TB infection occurs when the bacteria are present in the body but are not causing symptoms or spreading to others. Active TB disease occurs when the bacteria are actively multiplying and causing symptoms. Common symptoms of active TB include a persistent cough, chest pain, coughing up blood, fatigue, weight loss, fever, and night sweats.
Diagnosis: Diagnosis of TB involves several steps. Firstly, a medical history and physical examination are conducted to assess symptoms and risk factors. Following this, diagnostic tests such as the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) are used to determine if a person has been infected with TB bacteria. If these tests are positive, further tests such as chest X-rays, sputum tests, or cultures may be performed to confirm active TB disease and determine the most effective treatment.
Treatment and Prevention: Treatment for TB usually involves a combination of antibiotics taken for several months. Commonly used antibiotics include isoniazid, rifampin, ethambutol, and pyrazinamide. It's essential to complete the full course of treatment to prevent the development of drug-resistant strains of TB. Additionally, preventive measures such as vaccination with the Bacillus Calmette-Guérin (BCG) vaccine, good ventilation in living and working spaces, and early identification and treatment of active cases can help control the spread of TB.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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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.
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.
2. Updated based on the recent evidence and
advances in pediatric TB diagnosis and
treatment in consultation with IAPduring
January- February 2012.
3. Diagnosis of Pediatric TB
• All efforts should be made to demonstrate
bacteriological evidence in the diagnosis of
pediatric TB.
• Alternative specimens : (Gastric lavage,
Induced sputum, broncho-alveolar lavage).
4. • Optimal strength of tuberculin : 2 TU (RT 23
or equivalent) to be used for diagnosis in
children.
• A positive Tuberculin skin test / Mantoux
positive >=10 mm induration.
5. • No role for inaccurate/inconsistent diagnostics
like serology (IgM, IgG, IgA antibodies against
MTB antigens) , various in-house or
nonvalidated commercial PCR tests and BCG
test.
• Loss of weight was defined as a loss of > 5% of
the highest weight recorded in the past three
months.
12. Intermittent versus Daily regimen:
• The intermittent therapy will remain the mainstay
of T/t
• However, Among seriously ill ,severe disseminated
disease or neurotuberculosis, the chances of
vomiting or non-tolerance of oral drugs is high in
the initial phase.
- should be given daily supervised therapy
during hospital stay.
15. Newer Case definitions for pediatric TB
patients
A. Failure to respond:
- Who fails to have bacteriological
conversion to negative status or fails to
respond clinically or deteriorates after
12 weeks of compliant intensive phase.
(Alternative diagnoses/ reasons for
nonresponsiveness should be ruled out.)
16. B .Relapse :
- A case of pediatric TB declared cured or
completed therapy in past and now has
(clinical or bacteriological) evidence of recurrence.
C. Treatment after default :
- A case of pediatric TB who has taken treatment
for at least 4 weeks and comes after interruption of
treatment for 2 months or more and
has active disease (clinical or bacteriological).
17. D. Others :
- For programmatic purposes of reporting, all
types of retreatment cases where
bacteriological evidence could not be
demonstrated but decision to treat again was
taken on clinical grounds would continue to be
recorded and reported as “OTHERS” for
surveillance purposes.
18. Treatment Catagories:
• There will be only two treatment categories –
1. For treating ‘new’ cases
2. For treating ‘previously treated cases’.
20. • Smear positive: Any sample (sputum, induced
sputum, gastric lavage, broncho‐alveolar lavage)
positive for acid fast bacilli.
• New Case: A patient who has had no previous
ATT or for less than 4 weeks.
• Relapse: Patient declared cured/completed
therapy in past and has evidence of recurrence.
21. • Treatment after Default: A patient who has taken
treatment for at least 4 weeks and comes after
interruption of treatment for 2months and has
active disease.
• Failure to respond: A case of pediatric TB who fails
to have bacteriological conversion to negative
status or fails to respond
• Default : which do not fit the above definitions.
22. • TB Meningitis: During intensive phase of TB
Meningitis, Injection Streptomycin is to be
replaced byTab. Ethambutol
• Extending intensive and continuation phase:
Children who show poor or no response at 8
weeks of intensive phase should be given
extension of IP for one more month.
.
23. - In patients with TB Meningitis, spinal TB,
miliary/disseminated TB and osteoarticular TB,
the continuation phase shall be extended by 3
months making the total duration of treatment to
a total of 9 months.
- A further extension may be done for 3 more
months in continuation phase (making the total
duration of treatment to 12 months) on a case to
case basis in case of delayed response and as per
the discretion of the treating physician/
pediatrician
24. • TB preventive therapy: The dose of INH for
chemoprophylaxis is 10 mg/kg (instead of
currently recommended dosage of 5 mg/kg)
administered daily for 6 months.
• TB preventive therapy should be provided to:
a. All asymptomatic contacts (under 6 years of
age) of a smear positive case, after ruling out
active disease and irrespective of their BCG
or nutritional status.
25. b. Chemoprophylaxis is also recommended for
all HIV infected children who either had a
known exposure to an infectious TB case or
are Tuberculin skin test (TST) positive (>=5mm
induration) but have no active TB disease.
26. c. All Tuberculin positive children who are receiving
immunosuppressive therapy (e.g.Children with
nephrotic syndrome, acute leukemia, etc.)
d. A child born to mother who was diagnosed to
have TB in pregnancy should receive prophylaxis
for 6 months, provided congenital TB has been
ruled out. BCG vaccination can be given at birth
even if INH chemoprophylaxis is planned.
27. When to suspect pulmonary TB?
• Fever and / or cough of recent onset lasting
for > 2 weeks should arouse suspicion of
tuberculosis.
• Cough persisting beyond 2 weeks
• Recent unexplained loss of weight
• History of exposure to an infectious TB patient
(smear positive)
28. • Pneumonia not responding to antibiotic
therapy .
• Diagnosis is also more likely in presence of risk
factors such as recent history of measles or
whooping cough and immunocompromised
state including steroid therapy.
• Significant superficial lymphadenopathy
29. Extra-pulmonary Tuberculosis
• TB lymphadenitis
- progressive enlargement of lymph node for more
than 2 weeks, firm, minimally tender or not
tender,
sometimes fluctuating, may be matted and may
have chronic sinus formation.
- Fine needle aspiration cytology (FNAC) is usually
adequate for accurate diagnosis and it correlates
well with biopsy in >90% of cases.
30. - Histopathology
typically shows necrosis and epitheloid
granuloma.
- When FNAC is inconclusive, biopsy is
necessary for confirmation of diagnosis
31. • Pleural Effusion
- If chest X-ray is suggestive of pleural
effusion, pleural aspiration should always be
performed for biochemical, cytological and
smear examination by ZN stain to confirm the
diagnosis.
32. - Typically, a tubercular effusion fluid is straw
colored (pus, if aspirated, is very rarely due to
TB etiology) has large numbers of cells
(predominantly mononuclear), with high
proteins (>3g/dL).
- Adenosine Deaminase (ADA) levels over 60
IU/L may be suggestive of tuberculousis
33. • Tubercular meningitis (TBM)
- longer (>1 week) duration of fever, with vague CNS
symptoms such as behavior changes, irritability,
drowsiness, headache, vomiting and seizures.
- Physical examination reveals typically global
encephalopathy with focal deficits, hydrocephalus and
movement disorder.
- Risk factors for TBM include age < 5 years, contact
with an adult suffering from
tuberculosis, PEM grade III and IV, and HIV infection.
34. • Tuberculoma
-Often seen in older children, it may present
as a focal seizure or
-symptoms and signs of raised intracranial
tension with multiple localizing signs
35. Abdominal tuberculosis
- mesenteric lymphadenopathy, intestinal
disease,
peritoneal involvement or systemic
disseminated disease presenting as
hepatosplenomegaly.
- Large matted lymph node mass
- The ascitic tap should always be done in
such situations