This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
Fever, common cold and cough in pediatric age groups are common. Acute bronchiolitis is a diagnostic term used to describe the clinical picture produced by several different lower respiratory tract infections in infants and very young children (younger than 1yr ,some clinicians extend it to the age of 2 yr). Pneumonia defined as inflammation of lung parenchyma.
It is the leading infectious cause of death globally among children younger than 5 yr.
The introduction of antibiotics and vaccine against measles , pertussis ,haemophilus influenzae type b and PCV vaccine reduces the pneumonia related mortality over past 15 yr.
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...Riaz Rahman
Clinical overview of Community Acquired Pneumonia, Hospital Acquired Pneumonia, Aspiration Pneumonia. Covers pathophysiology, clinical management, prevention, risk stratification (pneumonia severity index), prognostic factors, complications. Includes case studies, comprehension questions. Given at Jackson Park Medical Center on 12/1/2013. Includes references.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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is the oldest recreational drug and likely contributes to more morbidity,
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The four main behavioral effects of AUD are impaired control over
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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
- 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
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
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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
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
1. Dr. Virendra Kumar Gupta
Assiociate Professor
Department Of Pediatrics
NIMS Medical College & Hospital , Jaipur
2. Pneumonia is definedas inflammation of the lung parenchyma.
(Ref: Nelson Text Book of Pediatrics 20th)
3. Epidemiology ..
Each year, about 156 million new episodes of pneumonia occur world
wide.
Among which 151 million episodes in developing countries.
(Ref: Epidemiology and Etiology of Childhood Pneumonia. Rudan I, Campbell, et al. Bull World
Health Organ 2008, May; 86(5):408-16.)
4. It is the leading cause of U5 mortality, globally accounting 16%of all U5 deaths.
Ref: WHO Fact sheet onPneumonia.
Epidemiology ..
5. Risk factors
1. Malnutrition (Z <-2)
2. LBW-(<2500gm)
3. Non exclusive BF
4. Lack of Immunization-(Measles,
Pentavalent Hib, Varicella)
5. Indoor air Pollution
6. Parental smoking
7. Overcrowding
8. Zinc deficiency
9. Poor care giving practice
10.Concomitant diseases (Diarrhoea,
Heart Diseases, Asthma etc.)
8. Etiology according to age
Age group Frequent pathogens
Neonates
( < 3 wk )
Group B streptococcus, E. coli & other Gram -vebacilli,
S. pneumoniae, H. influenziae typeb.
3 wk – 3 mo RSV & other respiratory viruses, S. pneumoniae,H.
influenziae type b, Chlamydiatrachomatis.
4 mo – 4 yr RSV & other respiratory viruses, S.pneumoniae, H.
influenziae type b, Mycoplasma pneumoniae,GAS.
≥ 5 yr Mycoplasma, Chlamydophila pneumoniae, Legionella, Str
pneumoniae, H. influenzae type b, Respiratoryviruses.
9. RECURRENT PNEUMONIA
Defined as 2 or more episodes in a single year or 3 or more episodes
ever, with radiographic clearing between occurrences.
An underlying disorder should be considered if a child experiences
recurrent pneumonia:
10. Recurrent pneumonia causes:
A. Hereditary disorders: Cystic Fibrosis, Sickle Cell Disease.
B. Disorders
Selective
of Immunity: HIV/AIDS, Brutons agammaglobinemia,
Ig deficiency, SCID, Chronic Granulomatous disease,
Leucocyte adhesiondefect.
C. Disorders of cilia: Kartagener syndrome, Immotile ciliasyndrome.
Disorders:D. Anatomic Pulmonary sequestration, Lobar emphysema,
GER, TEF (H type), Bronchiectasis.
12. Pathogenesis
•Inhalation of droplet nuclei
•Hematogenous seeding
•Aspiration
Colonization of organism in
respiratory passage
Inflammatory reaction in
respiratory tract including lung
parenchyma
13. Stages of pneumonia
Stage of congestion: Lung parenchyma filled with inflammatory
exudate.
Stage of red hepatization: massive exudation with red cells,
neutrophil & fibrin inalveoli.
Stage of grey hepatization: progressive disintegration of RBC with
greyish brown discoloration.
Stage of resolution: Progressive removal of exudate from alveolar
space.
14. In VIRAL PNEUMONIA, low grade fever is usually present, along with
other features of respiratorydistress:
1. Tachypnea ( mostconsistent C/F),
2. Increased work of breathing evident by intercostal, subcostal, and
suprasternal retractions, nasal flaring, and use of accessory muscles,
4. hyper resonant chests
3. cyanosis and lethargy in case of severeinfection,
with crackles & wheezing.
Clinical Manifestations
15. BACTERIAL pneumonia is characterized by:
1. sudden high grade fever, cough, and chestpain.
2. Drowsiness , occasionally with delirium
3. Along with usual signs of respiratory distress, i.e. tachypnea,
grunting, nasal f laring; retractions of the supraclavicular, intercostal,
and subcostal areas & oftencyanosis.
18. IMCI: Day1 – 2m
Fast breathing,
Severe chest indrawing ,
grunting,
hypo/ hyperthermia,
not feeding well,
convulsion.
Anyof these is classified as very severedisease.
20. Chest X-Ray
Viral pneumonia is usually characterized by:
1. hyperinflation with bilateral interstitial infiltrates and
2. peribronchial cuffing .
Confluent lobar consolidation &/or pleural effusion is typically seen
with pneumococcal pneumonia .
22. CBC
In viral pneumonia: WBC-normal or usually not higher than
20,000/mm3, with a lymphocyte predominance.
In bacterial pneumonia: Elevated WBC count, 15,000-
40,000/mm3 with predominance of granulocytes.
23. Acute phase reactants (ESR, CRP):
Higher in bacterial, normal or slightly raised in viral pneumonia.
Blood culture: Blood culture results are positive in only10%.
24. TREATMENT
Treatment of suspected bacterial pneumonia is based on the presumptive
cause,age and clinical appearance of the child.
For mildly ill children who do not require hospitalization, amoxicillin is
recommended.
With the emergence of penicillin-resistant pneumococci, high doses of
amoxicillin (80-90 mg/kg/24 hr) should be prescribed.
Therapeutic alternatives include cefuroxime axetil and amoxicillin/clavulanate.
25. For school-aged children and in children with suggested infection of
M. Pneumoniae or C. pneumoniae , a macrolide antibiotic such as
azithromycin is an appropriatechoice.
In adolescents, a respiratory f luoroquinolone (levofloxacin,
moxifloxacin) may be considered as analternative.
26. The empiric treatment of suspected bacterial pneumonia in a hospitalized
child start on theclinical manifestations at the time ofpresentation.
27. Indications for admission to hospital
Young age - < 6 months ofage;
Toxicappearance
Moderate to severe respiratorydistress
Inabilityof family toprovidecareat home;
Failure of outpatienttherapy;
Complicated pneumonia
Vomiting or inability to tolerateoral fluid or medications.
Immunocompromised state
28. Treatment after hospital admission
Supportive care forchildren
Oxygen, if needed (SpO2-<92%)
Fluids and ensurehydration
Antipyretics, analgesics
Antibiotics
29. 1. In areas without substantial high-level penicillin resistance among S.
pneumoniae,
immunized against H. inf luenzae type b and S.2. children who are fully
pneumoniaeand
3. are not severely ill should receiveampicillin or penicillin G.
For children who do not meet these criteria, ceftriaxone or cefotaxime should be
pneumonia initial antimicrobial
used.
If clinical features suggest staphylococcal
therapy vancomycin orclindamycin.
30. to withhold If viral pneumonia is suspected, it is reasonable
antibiotic therapy, especially for thosepatients
who are mildlyill,
have clinical evidencesuggesting viral infection and
are in no respiratory distress.
31. The optimal duration of antibiotic treatment for pneumonia has not been well-
established in controlled studies.
Antibiotics should generally be continued until the patient has been afebrile for
72 hr, and the total duration should not be < 10 days (or 5 days forazithromycin).
Shorter courses (5-7 days) may also be effective, particularly for children
managed on an outpatientbasis.
In developing countries, oral zinc (10 mg/day for <12 mo, 20 mg/day for ≥12 mo)
is advised toreduce mortality among children.
34. Prognosis
Typically, patients with uncomplicated community-acquired bacterial
cough,pneumonia show improvement in clinical symptoms (fever,
tachypnea, chest pain), within 48-96 hours of initiation of antibiotics.
Radiographic evidence of improvement lags substantially behind clinical
improvement. It may take 6 to 8 weeks to return to normal.
35. When a patientdoes not improvewith appropriateantibiotic therapy
complications, suchas
1. empyema
2. bacterial resistance
3. nonbacterial etiologies such as virusesor fungi and aspirationof foreign
bodies orfood
4. preexisting diseasessuch as immuno deficiencies, ciliary dyskinesia,cystic
fibrosis, pulmonary sequestration or congenital pulmonary airway
malformation and
5. other noninfectiouscauses including bronchiolitis obliterans,
hypersensitivity pneumonitis, eosinophilic pneumonia, aspirationand
granulomatosis with polyangitis are suspected.
36. is done to determine the reason for delay in response to A repeat chest X-ray
treatment.
Bronchoalveolar lavage may be indicated in children with respiratory failure.
High-resolution CT scans may better to identify complications or an anatomic
reason.
37. Prevention
1.Exclusive Breastfeeding up to 6 months of age .
2.Immunization against with-- Hib, PCV,Measles,
Pertussis, Varicella.
3.Adequete Nutrition---Under nutritioncauses >1 millionsdeath under 5
due toPneumonia.
4.Hand washing, safe water drinking & prevention of Diarrhoea.
5.Avoidanceof parental orothersortsof secondary & tertiary smoking.
6.Free from indoor airpollution.
7.Zincsupplementation.
38.
39. Q-1 Most dangerous sign in LRTI in Children is ?
A-Abdominal Breathing
B-Chest Retraction
C-Grunting
D-Tachypnoea
40. Q-2 WHO criteria for hospital Admission in Pneumonia ?
A-High Fever
B-Nasal Flaring
C-Difficulty in breathing
D-Chest Indrawing
41. Q-3 Which is the following is leading cause of mortality in Under 5 children in
developing countries?
A-Malaria
B-Acute lower respiratory tract infections
C- Hepatits
D-Prematurity
42. Q-4 Pneumothorax Could be a complication of ?
A-Staphyllococcal Pneumonia
B-Pneumococcal Pneumonia
C-Klebsiella Pneumonia
D-Viral Pneomonia
43. Q-5 A 4 year old malnourished child is brought to subcentre with breathing rate
of 55/ min., Excessive crying, irritability, fever and not taking feeds. The ANM
assesses the child and categorizes under the IMNCI guidelines for the
management of ARI as ?
A-No Pneumonia
B-Very Severe Disease
C-Pneumonia
D-Upper Respiratory Tract infection