This document discusses neonatal jaundice, including its definition, pathophysiology, types, complications, and management. Key points include:
- Jaundice is caused by a buildup of bilirubin, which appears yellow. It is visible in newborns when bilirubin levels reach 5 mg/dL.
- Physiological jaundice is common in newborns and resolves on its own. Pathological jaundice requires treatment to prevent complications like kernicterus.
- Causes of neonatal jaundice include an imbalance between bilirubin production and excretion, as well as breastfeeding issues. Treatment depends on the type and severity of jaundice
Management of child with neonatal jaundiceNEHA MALIK
Newborn jaundice is a yellowing of a baby's skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during normal breakdown of red blood cells.
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Management of child with neonatal jaundiceNEHA MALIK
Newborn jaundice is a yellowing of a baby's skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during normal breakdown of red blood cells.
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Please find the power point on Phototherapy in jaundice . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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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!
2. • Definition of jaundice
• Metabolism of bilirubin
• Pathophysiology of neonatal jaundice
• Types of neonatal jaundice
• Complications of jaundice
• Management of neonatal jaundice
3. • Jaundice is yellow color of the skin and sclerae
caused by deposits of bilirubin.
• When is it visible?
– Adult sclera > 2 mg / dL
– Newborn skin > 5 mg / dL
7. • Appears after 24 hours
• Total bilirubin rises by less than 5 mg/dl pe day
• Maximum intensity by 4th-5th day in term &
• 7th day in preterm
• Serum level less than 15 mg / dl
• Clinically not detectable after 14 days
Physiological
• Appears age Appears within 24 hours of age
• Increase of bilirubin > 5 mg / dl / day
• Serum bilirubin > 15 mg / dl
• Jaundice persisting after 14 days
• Direct bilirubin > 2 mg / dl
• Child sick
Pathological
8. • Serum TB level of most newborn infants rises
to > 2 mg/dL in the first week after birth.
1. Increased RBC volume per kilogram and decreased RBC survival
in infants compared to adults
2. Increased ineffective erythropoiesis and
3. increased turnover of nonhemoglobin heme proteins
1. Decreased ligandin
2. Decrease in binding of ligandin by other anions
1. Decreased activity of the gene UGT1A1.
(UDP-Glucuronyl Transferase 1A1)
1. Decreased intestinal bacteria, and
2. Decreased gut motility with poor evacuation of
bilirubin-laden meconium
A. Increased Bilirubin production
B. Defective uptake of bilirubin from plasm
C. Decreased clearance
D. Decreased hepatic excretion
9.
10. • Breastfeeding jaundice is the result of the baby
not receiving enough milk to lower their
bilirubin levels.
• This causes the bilirubin to be reabsorbed into
the intestines and keep the levels elevated
which triggers jaundice.
• This usually occurs in the first week of life while
the baby and mother are in the early stages of
learning how to breastfeed.
11. • It develops after the first 5 to 7 days of life and peaks at
about 2 – 3 wks up to 10 mg/dL
• It is linked to some type of substance in the breast milk that
inhibits the liver's ability to break down and process
bilirubin leading to increased concentration of beta-
glucuronidase in breast milk, causing an increase in the
deconjugation and reabsorption of bilirubin.
• Mothers should be advised to continue breastfeeding at
frequent intervals and TSB levels usually decline over a
period of time.
12. • Jaundice appears
– in the first 24 h,
– after the first week of life, or
– lasts > 2 wk
• Total serum bilirubin rises by > 5 mg/dL/day (> 86 mMol/L/day)
• Total serum bilirubin is > 18 mg/dL (> 308 mMol/L/day)
• Infant shows symptoms or signs of a serious illness
• Rate of rise of total serum bilirubin > 0.2 mg/dL/h (> 3.4 mMol/L/h)
or > 5 mg/dL/day (> 86 mMol/L/day)
• Conjugated bilirubin concentration > 1 mg/dL (> 17 mMol/L) if TSB
is < 5 mg/dL (< 86 mMol/L) or > 20% of TSB (suggests neonatal
cholestasis)
13. • When the plasma concentration of
unconjugated bilirubin exceeds that which can
be tightly bound by albumin (20-25 mg/dL),
bilirubin can penetrate the blood-brain barrier.
• If left untreated, the resulting
– hyperbilirubinemic toxic encephalopathy, or
kernicterus,
– can result in mental retardation
14. 1. Hemolytic
• Rh , ABO and other blood group incompatibilities
• spherocytosis , elliptocytosis, Alpha thalassemia
• Sepsis, DIC
• Hematomas
• Polycythaemia
2. Non hemolytic
• Breast milk jaundice
• Crigler-Najjar syndrome, types I and II
• Gilbert syndrome
15. • It is an isoimmune hemolysis
associated with
– Rh incompatibility or
– ABO
An Rh+ man and an
Rh – woman coul
dhave an Rh + baby`
1st Pregnancy: At birth some of
the Rh+ blood of fetus may
enter mother’s circulation``
After delivery: The mother
forms anti-Rh antibodies
over next few months
2nd pregnancy with Rh+
fetus: Anti-Rh antibodies
pass into the fetus causing
its blood cells to lyse
19. • First Line
– Total & direct bilirubin
– Blood group and Rh for mother and baby*
– peripheral smear – e/o of hemolysis
• Second Line
– Hematocrit,
– Retic count - increased in hemolysis
– Direct Coomb’s test – to detect immune hemolysis
– G6PD assay
– Sepsis screen
– Liver and thyroid function
• Third Line
– TORCH titers
– Liver scan when conjugated hyperbilirubinemia
– Ultrasonography of the liver and bile ducts in cholestatsis
20. • Measurement of bilirubin by
jaundice meter –
– Trans-cutaneous bilirubin levels
21.
22. • Catabolism of heme derived from red cell hemoglobin
produces equimolar amounts of CO and bilirubin
• An ETCOc cutoff of more than 2.5 parts per million to
predict the presence of clinically significant hemolysis
23. Score Interpretation
1–3 Subtle signs of acute bilirubin encephalopathy in infants with
hyperbilirubinemia
4–6 Moderate acute bilirubin encephalopathy and are likely reversible with
urgent and prompt bilirubin reduction strategies.
7–9 Advanced acute bilirubin encephalopathy; urgent, prompt, and
individualized intervention are recommended to prevent further brain
damage, minimize severity of sequelae, and possibly reverse acute
damage
25. • Configurational
Isomerization
– Z isomers are converted to E
isomers
• Structural Isomerization
– Bilirubin converted to
lumirubin
• Photo oxidation
– This is a minor reaction,
where photo-products are
excreted in urine.
26. • Increased insensible water loss
• Loose stools
• Skin rash
• Bronze baby syndrome
• Hyperthermia
• May result in hypocalcemia
27. Indications
• Double volume exchange transfusion
– Cord bilirubin 5 mg/dL
– Cord Hb is 10 g / dL or less
– Hydrops fetalis at birth
• Partial Exchange Transfusion
– CHF in presence of low PCV (< 35%)
28. • Occurs when unconjugated
hyperbirubinemia as
unconjugated bilirubin can
cross across the blood brain
barriers
• When plasma levels exceed
that which can be tightly bound
albumin at 25 mg/dL
29. • Identification of Rh incompatibility antenatally and
administration of Anti D (RhoGam) to mother
• Ensuring adequate breast feeding
• Follow up of high risk newborn
• Explaining red flag signs to parents
30. Conjugated hyperbilirubinemia is defined by a
direct or conjugated bilirubin level >1 mg/dL or
>15% of the TB level.
May be caused by
– defects in intrahepatic bile production,
– defects in transmembrane transport of bile, or
– mechanical obstruction to flow
31. • Associated with hepatomegaly, splenomegaly, pale
stools, and dark urine
Normal Stool Acholic Stool
32. • Obstructive bile duct disorders: Biliary atresia, Choledochal duct cysts
• Infectious causes: sepsis and urinary tract infections
• Metabolic disorders: α1-antitrypsin deficiency, cystic fibrosis,
tyrosinemia, galactosemia, storage diseases
• Immunologic disorders: alloimmune liver disease and neonatal lupus
erythematosus
• Endocrine disorders: Hypothyroidism and panhypopituitarism.
• Toxic disorders: total parenteral nutrition (TPN) including lipid
33. • History: Acholic stools and dark urine
• Laboratory studies: total and direct or conjugated bilirubin, serum alanine aminotransferase
(ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline
phosphatase, and coagulation studies
• Abdominal ultrasonography
• Hepatobiliary scintigraphy with technetium-labelled iminodiacetic acid
• Percutaneous liver biopsy
• intraoperative cholangiography
34. • Enteral feedings, even at minimal volumes of
10 mL/kg/day, are initiated as soon as
possible.
• Discontinue intralipid administration and
substitute parenteral fish oil or fish oil
emulsion
• Surgery: for Congenital biliary atresia –
hepaoportoenterostoly (Kasai Procedure)