1. The document discusses clinical findings, diagnostic testing, risk factors, prevention, and treatment options for acute otitis media and otitis media with effusion.
2. Treatment options include observation, antibiotics, myringotomy, tympanostomy tube insertion, adenoidectomy, and eustachian tube dilation.
3. Complications of tympanostomy tube insertion include acute otorrhea, persistent perforation, early extrusion, and tube blockage.
Otitis is one of the most frequent diseases in early childhood and one of the reasons for first prescription of antibiotics.
Most frequently reported pediatric bacterial infection, with up to 85% of children experiencing an episode by the age of 3 years and many of them have to treat with medicine and surgical management is restricted
Parotitis is the inflammation of the parotid glands. It is the most common inflammatory condition of the salivary glands, although inflammation can occur in the other salivary glands as well.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Otitis is one of the most frequent diseases in early childhood and one of the reasons for first prescription of antibiotics.
Most frequently reported pediatric bacterial infection, with up to 85% of children experiencing an episode by the age of 3 years and many of them have to treat with medicine and surgical management is restricted
Parotitis is the inflammation of the parotid glands. It is the most common inflammatory condition of the salivary glands, although inflammation can occur in the other salivary glands as well.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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
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
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.
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
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
17. Clinical Finding
• The normal TM is pearly gray, translucent, and
concave
• A visible landmark
• A red but translucent TM…. Crying
• A pink, yellow, or blue TM ,lack of translucency
and Bulging TM is key diagnostic feature of AOM
• shagrination (cobble stoning) of the TM
18.
19.
20.
21.
22.
23. Tympanometry (Immittance Testing)
• Normally 0.3 to 0.9 mL in children
• generally performed using a 226-Hz tone
• 1000-Hz probe best for young chil less than 6mo
• Due to increased compliance of EAC
• Compared to pneumatic otoscopy, tympanometry is
easier to perform and has a comparable sensitivity
but a lower specificity for diagnosing OME
24.
25.
26. Risk Factors
• Range of host-related and environmental factors
• Onset of first AOM before 12 months of age is a
powerful predictor of recurrence
• Host related: male sex, genetic, craniofacial
abnormalities, immunodeficiency, hypertrophy of the
adenoids,
• Environmental: socioeconomic status, recurrent URTI,
fall and winter season, daycare, having older siblings,
tobacco smoke exposure, pacifier use
• Breastfeeding protects against OM.
• Debate regarding the role of: prematurity, allergy,
obesity, gastroesophageal reflux
27.
28. The eustachian tube
• Epithelium predominantly consists of ciliated
• Which produce antimicrobial proteins
• Goblet cells, produce both mucoid and serous
• The direction flow from the middle ear
through the eustachian tube to the
nasopharynx
• Against bacterial colonization of the middle
ear.
29.
30. Bacterial Colonization and Biofilms
• Bacterial biofilms: sessile communities of
interacting bacteria encased in protective matrix
of exopolysaccharides and adherent to surface.
• The matrix protects bacteria against host's
immune response, and reduced metabolic rate of
bacteria renders them resistant to antibiotics.
• Mucosal biofilms have been isolated from middle
ear of patients with persistent OME, CSOM, and
cholesteatoma
31. • Low IgA, IgG2 and mannose-binding lectin
levels
• Allergy There is still debate on the role in the
pathogenesis of OM
• Genetics: Estimates of heritability of AOM
and OME vary from 40% to 70%
• A cause-effect relationship between
gastroesophageal reflux and OM remains
unclear, antireflux treatment is currently not
recommended
39. Treatment
Acute Otitis Media
Observation With Close Monitoring (Watchful Waiting)
• An option for young children (6 to 23 months of age) with
nonsevere unilateral AOM
• Children 24 months and older with nonsevere unilateral or
bilateral AOM.
• “Nonsevere” is defined as “without severe signs or symptoms,
mild otalgia for less than 48 hours, temperature less than
39°C ”
• Follow-up is recommended in case the child worsens or fails
to improve within 48 to 72 hours of the onset of symptoms.
40. Medical Treatment
• Analgesics.
• Antibiotics.
• Decongestants and Antihistamines
(routine use not recommended)
• Corticosteroids (not recommended)
41. Antibiotics.
• Reduce the duration and severity
• Associated with adverse effects
• Emerging antimicrobial resistance
• Benefits and costs of antibiotic treatment
• are most effective in:
1. children below 2 years
2. with bilateral AOM
3. any age presenting with AOM and otorrhea
4. children with severe illness
5. AOM who are below 6 months of age
6. Immunocompromised
7. have craniofacial malformations
42. Amoxicillin is still the first-line
• 80 to 90 mg/kg /day in two divided doses
• including resistant strains
• Amoxicillin–clavulanic acid (amoxicillin 90 mg/kg/day
and clavulanic acid 6.4 mg/kg/day in two divided doses
• recommended for children:
1. who have been treated with amoxicillin in the previous 30
days
2. for those with concurrent purulent conjunctivitis (e.g.,
otitis-conjunctivitis syndrome typically caused by
nontypeable H. influenzae)
3. for those with a history of recurrent AOM unresponsive to
amoxicillin.
43. For patients with penicillin ALLERGY
• Cephalosporins such as cefdinir, cefuroxime,
cefpodoxime, and ceftriaxone are acceptable
first-line treatment
• If initial treatment failure occurs:
– broader-spectrum agent such as amoxicillin–
clavulanic acid
1. ceftriaxone, 50 mg intramuscularly or
intravenously for 3 days if amoxicillin–clavulanic
acid was not effective
• Tympanocentesis
44. Course
Standard 10-day therapy for younger children
and for children with severe disease
A 7-day course in children 2 to 5 years of age
with mild to moderate AOM
6 years of age and older with mild to moderate
disease, 5- to 7-day course
49. Recurrent Acute Otitis Media
• Defined as three or more episodes in 6
months or four in 1 year with at least one
episode in the last 6 months
50. Antibiotic Prophylaxis
• Older studies efficacy of prophylactic
antibiotics
• Mostly amoxicillin and sulfisoxazole
• Given at half of the therapeutic daily
dose for months
• Prophylaxis reduces AOM recurrences by
one to two episodes per year
• Routine use is not recommended
• Given the adverse effects
• Emerging antibiotic resistance.
51. Surgical Treatment
• Myringotomy With Tympanostomy Tube
Insertion
• 2013 guidelines American Academy recommend
against rAOM without MEE
• Recommend for rAOM with MEE
rAOM
52. Adenoidectomy
• A recent meta-analysis combining individual
patient data of 10 randomized controlled
trials:
a standalone procedure or as an adjunct to
tympanostomy tubes
• is most beneficial in children below 2 years of
age with rAOM
53. Otitis Media With Effusion
• Observation With Close Monitoring
(Watchful Waiting)
• A 3-month period of observation
– who are not at particular risk for speech and
language or learning disabilities
– Examination at 3- to 6-month intervals
– surgical intervention for high risk child (delay
development)
54.
55.
56.
57.
58. Medical Treatment
1. Antibiotics (are not recommended for
routine treatment)
2. Decongestants and Antihistamines ( not
recommended )
3. Corticosteroids (Both oral and topical are
therefore not recommended )
4. Auto-inflation (larger trials are required)
• Hearing Aids (are recommended in UK, but
not in US)
59. Surgical Treatment
• Myringotomy
ineffective for long-term management and is not
recommended
• Myringotomy With Tympanostomy Tube
Insertion
• Adenoidectomy
• Eustachian Tube Dilatation
60. Myringotomy With Tympanostomy
Tube Insertion
• Effect on hearing is modest and diminishes after 6 to 9
months
1. Largest effect in young children that grow up in an
environment with a high infection load (e.g., children
daycare)
2. In older children with a hearing level of 25 dB HL or
greater in both ears persisting for at least 3 months
3. in children with OME with documented hearing
difficulties after 3 months
4. Those who are at particular risk for, or who already
have, speech and language or learning disabilities
61. Adenoidectomy
• As a standalone procedure or as an adjunct to
tympanostomy tube insertion
• Is most beneficial in children aged 4 years
62.
63. Eustachian Tube Dilatation
• Novel treatment for children with persistent
OME
• Currently no evidence to support
64.
65. Surgical Issues
• A follow-up visit is recommended within 2 to 3 months
after the surgery
• Evaluated 6 to 12 months after the insertion of the tubes
• Every 6 months thereafter
• T-tubes or longterm tubes are used in older children
who have an atrophic TM or who have had multiple sets
of tympanostomy tubes due to comorbidities such as
cleft palate, because a regular grommet tube may be
very quickly extruded.
66. If MEE is too thick:
• Large suction tip through the myringotomy
incision, a counterincision is made in the
inferior part of the TM, or sterile saline may
be irrigated in the canal or through the
myringotomy to enhance theaspiration of the
viscous fluid.
68. Complications and Sequelae
• Acute Tympanostomy Tube Otorrhea
• An estimated 25% to 75%
• Risk factors include:
– Young age
– rAOM
– Recent history of recurrent URTIs
– Presence of older siblings
69. Prevention of Otorrhea Episodes
Occurring in the Immediate
Postoperative Period.
1) Multiple saline washouts of the middle ear
2) A single application of antibiotic-
corticosteroid ear drops during surgery
3) Prolonged use of topical or oral antibiotics
with or without corticosteroids during the
early postoperative period
4) Single application of 6% ciprofloxacin otic
suspension in the middle ear during tube
insertion
70. Treatment of Otorrhea Episodes
Occurring Outside the Immediate
Postoperative Period
• Nontypeable H. influenzae, Staphylococcus
aureus, and Pseudomonas
• Current guidance recommends: ototopical
antibiotic drops as the firstline treatment
• If the otorrhea does not resolve in 2 weeks, it
is recommended that a culture specimen
• In case of persistent or frequently recurring
otorrhea, removal of the tubes
71.
72.
73. Notes
• Persistent Perforation can be surgically managed
if: As a rule, the TM in the opposite ear should be
intact and free of infection for 1 year
• Early Extrusion: infection in the middle ear, tube
may not properly inserted, TM thick, Atrophy of
the TM
• Tube Blockage: pick, Rosen needle, drop 14 days,
left in place and watched,.. replacement of the
tube
74. • Many clinicians recommend removing tubes
that have failed to extrude after 3 years to
reduce the risk of long-term perforation.
• Recent systematic reviews found no significant
impact of water precautions on the risk of
tympanostomy tube-associated otorrhea
• May be prudent for some children such as
those with
– Recurrent episodes of otorrhea, particularly with
Pseudomonas or S. aureus, and those with risk
factors for infections and complications.