This document presents a case report of an 8-month-old male child brought to the hospital with a 3-month history of persistent cough, fever, and weight loss. On examination, the child was found to be wasted and underweight. Investigations showed anemia, lymphocytosis, and a positive urine TB-LAM test. The child was diagnosed with pulmonary TB, severe acute malnutrition, and suspected HIV infection. He was admitted and started on anti-TB treatment and therapeutic feeding for malnutrition. However, the mother discharged the child against medical advice after only a few days of treatment.
Case presentation on mengoencephalitis |Inflammation of the brain NEHA MALIK
Inflammation of the brain and surrounding tissues, usually caused by infection.
Meningoencephalitis is a condition that's usually caused by a virus, bacterium, parasite or other microorganism. Examples include West Nile virus, mumps or tuberculosis.
Symptoms vary, depending on the cause. They may include fever, confusion, vomiting, seizures or, if left untreated, death.
Treatment may include antibiotics, antivirals or supportive care, depending on the origin of the disease.
Case 2S [symptoms] 10 month male presents to pediatrician’s offic.pdfsiennatimbok52331
Case 2
S [symptoms]: 10 month male presents to pediatrician’s office with chief complaint of fever and
rash. In usual state of health until 4 days prior to presentation when developed fever, fussiness
and decreased appetite. Mom thought maybe had thrush again because she noted some white
spots in his mouth a day after the fever started but they went away on their own. Last night she
noticed that his eyes started to appear more red and irritated, is now coughing and very
congested and this morning developed rash on face prompting visit
ROS [review of systems]: as above, no emesis, no constipation or diarrhea, +fewer wet diapers
than usual
PMHx [past medical history]: full term, uncomplicated pregnancy and delivery, neonatal
jaundice but did not require phototherapy, thrush at 6 weeks and 3 months of age treated with
nystatin
SHx [social history]: lives with parents and 2 yo sibling who is enrolled in child care. Flew to
California with family 3 weeks ago to visit grandparents, no other travel hx.
Imm: UTD [up to date]
Exam: T- 39.8 [temperature, C]; R -34 [respiratory rate]; P -120 [pulse]; BP-85/62 [blood
pressure]; Pox-98% in room air [pulse oximetry, oxygenation of blood]
Gen [general]: Alert, fussy infant on mom’s lap, crying with exam
HEENT [head, eyes, ear, nose, throat]: Normocephalic/atraumatic, anterior fontanelle fibrous but
flat, extraocular movements intact, pupils equal and reactive to light, +conjunctival erythema
bilaterally without discharge or crusting, nares congested, oropharynx erythematous with
sloughing of buccal and labial mucosa. Tympanic membranes erythematous but with intact
landmarks and light reflex
Neck: supple full range of motion, +1cm bilateral anterior cervical lymphadenopathy
RESP [respiratory]: mildly tachypneic with fair air exchange all fields, +subcostal retractions no
intracostal or suprasternal accessory muscle use, diffuse crackles audible on auscultation all lung
fields no wheezing or rhonchi
COR [cardiac]: tachycardic, regular, nl s1 and split s2, no murmurs, rubs or gallops
Abdomen: soft, normoactive bowel sounds, nontender non distended, no hepatosplenomegaly, no
masses
GU [genital/urinary]: circumcised tanner I male, no rashes
Skin: diffuse erythematous blanching maculopapular rash most prominent/confluent on face,
neck, and upper trunk, palms and soles spared, no desquamation
Extremities: warm and well perfused
a) What were the spots in the infant’s mouth that the mother mistook for thrush?
b) What is your diagnosis, and which symptoms lead you to this conclusion?
c) Which tests will you order to confirm this diagnosis (give the name and state what is being
measured)?
d) The patient is up to date on his vaccinations, so why was he susceptible to this disease? Where
did he likely contract the disease?
e) In an uncomplicated form, this condition is not usually fatal, but what can cause fatalities for
patients with this infection?
f) A similar patient might be admitted to the hospital or might not fo.
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!
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
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
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
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.
4. An 8 months old HIV exposed child who never
had attended the EID clinic ,with hx of close
contact with a person who had a chronic
cough. Was fairly well until at 4 months of age
when he developed gradual onset persistent
non productive cough that had progressively
worsened over the past 2 months, associated
with fast breathing , mildly relieved by some
herbal oral remedy, however with no hx of
DIB, no hx of coughing up blood ,
HxPC
5. no hx of easy fatigability and no hx of any body
swelling.
Mother also reported an equal duration hx of
high grade fever which was on and off at its
onset that gradually become constant over the
past month , worse in the evening and
temporarily relived by tabs paracetamol.
However with no hx of drenching night sweats,
no hx of LOC or any convulsions
Conti…
6. child also had 3/12 hx of progressive weight loss
despite having a good appetite according to
the mother. With no other GIT symptoms.
He was managed for Pneumonia and malaria in
several clinics on both intravenous and oral
medications with no relief of symptoms., which
prompted the mother to seek care at MRRH
Conti…
7. HEENT. Mother reported a 1/12 hx of child having a
fowl smelling thick greenish nasal discharge. On and
off. With no complaints in EET
GUS. Reported reduced urine out put a week prior to
admission( 2-3 times in 24hrs), yellow in color
however was of normal smell and the child did not cry
while passing the urine.
MSS . Had no complaint . SKIN. No complaint.
Review of systems
8. Mother never attended ANC
Suffered 2 episodes of febrile illness in early pregnancy.
Had a home delivery at term. child cried immediately
Cord was poorly tired and bled . child rushed to a nearby
hospital(mukono) where he was treated on oxygen and
glucose for about 24hours
Child didn’t suffer jaundice , no fever in early life
Breast fed after 24hours
Mother suffered no birth related complications
Gestation and delivery Hx
9. Child exclusively breast fed for up to 5 months of age
After which was introduced to cows milk, plain tea
and passion fruit juice. Had aprox 5 feeds a day
served by the mother
an attempt was made on other home foods which the
child refused to take .
Currently the child survived on the above drinks and
breast milk and reportedly had a very good appetite
Nutritional Hx
10. Social smile at 3 months
Head support 3 month
Turning in bed 3 month , supine to prone.
Sat with support 4month without support at 5
months
and this is his current level of motor development
Developmental hx
11. Child had Zero immunization
Immunizations hx
12. HIV exposed child , not attending EID clinic. has been
admitted several times to clinics and hospitals where
he was treated majorly for pneumonia and malaria.
Suffered measles at 6.5 months of age, treated at a
health facility in Mukono,
child was not on any chronic medication ,
Had no known allergy to any foods or any medicines
PMHx
13. Was unremarkable ,
Never received BT
Never undergone any surgical
procedure.
PSHX
14. Reported no familial illness known to her
among the child's paternal and maternal
relatives like DM , heart disease , asthma etc.
Mother is known is known ISS pt , who had
been on HAART for 8 yrs. gets her HIV care
from a H/C in mukono. Had no recent viral
load/ CD4 count done on her.
Family hx
15. Child is the 5th born to his mother, 3 of his older
siblings are born to another father , and are
reportedly in a good health condition. Child stays with
mother and father and 3 other children in a one
roomed house, which has one window and door.
Mother is a canteen attendant, and father sales man
in a supermarket around town
Neither of the child's parents drinks alcohol or
smokes cigarette or any other elicit drugs
Social hx
16. NA an 8/12 months old male HIV exposed child
was, whose mother had not enrolled for
PTMCT, brought in with 3 months hx persistent
non productive cough, associated with fast
breathing and an equal duration hx of high
grade fever with associated progressive weight
loss. However with no hx of hemoptysis , DIB
and no history of drenching night sweats.
Summery
17. A. HIV exposed child with PTB in view of
Hx of potential exposure.
Long standing Hx of B symptoms.(cough , fever and weight loss)
Un responsive to conventional therapy for alternative Dxs
B Severe acute malnutrition (SAM) in view of :
Hx of weight loss and failure to gain weight
Developmental delay ( evidenced by his current mile stones)
Poor nutritional hx
C Pneumonia in vie w of cough ,fast breathing and cough
D malignant process ?? Lymphoma … B symptoms
R/O Malaria.
R/O Septicemia.
The above signs and symptoms were
suggestive of
18. On examination
G/E
Child was visibly wasted
(prominent zygomas)
Total Boldness
With a wide anterior fontanel.
Neither sunken nor bulging
Febrile to touch
Eyes not sunken , no jaundice.
With no eye signs of vit A defi
Pale conjunctiva
Lips were dry
Had no central cyanosis
No oral lesions , has only 2 lower
central incisors, with no any visible
gingival bleeding.
Had generalized palpable
lymphadenopathy , largest were Lf
anterior cervical , discrete, soft and
mobile.
No finger clubbing
Capillary refill time <2 seconds
Had normal skin turgor with
multiple hyper pigmented macules
Had no edema
19. Conti…
Anthropometry
Weight 5.1kg
Length not taken
MUAC 10.1cm
Z score < -3 SD… this score
score diagnostic of SAM
Head and chest
circumferences …weren't
taken.
Vitals at admission
RR 60 cycles /min
HR 145 b/min
BP not taken
Temp 39.1 C
PSO2 95 %
RBS……
20. Systems Exam
RS
Child had no signs of distress
Ribs were prominent however
with no rachitic rosary
Harrison's sulcus?
Chest wall symmetrical
Moving regularly with
respiration . (tachypnea) and
symmetrically expanding.
Trachea was central
chest wall non tender
Had normal tactile fremitus
Chest wall resonant to
percussion.
with brochovascular with
breath sounds, no wheezes
and no crackles.
21. Cont..
CVS
Pulse small volume , regular
at a rate of 145b/m and
synchronous radial-radial
and radial-femoral
BP……..….
Neck vessels not distended
Precordium normal active,
apex 4ICS MAL
HS I & II heard . No added
sounds
CNS
Child was alert ,
Not lethargic
Neck was soft (no signs of
meningeal irritation)
No obvious cranialpathies
Motor -child had normal
tone , normal reflexes
Sensory - intact
22. Cont..
PER ABDOMEN
Significant findings
Distended however
symmetrical .
Non tender to palpation
No organs or any masses
were palpable
Hyper resonant to
percussion .
Bowel sounds present 3-5
every 10 min
MSS
Was un remarkable
23. Investigations
Hematologic
RBS – for the glycemic
status.
CBC- WBCs , RBCs and there
differential counts + PLT
BS for MPS to R/O malaria
Serum electrolytes- look out
for any derangements
DBS for PCR - confirm HIV
Sero-status of the child.
Blood culture &sensitivity
Sputum analysis
G/s , culture and sensitivity…
ZN & Gene x-pert for TB/Ref
Urine analysis. R/O the gut as a
potential infection focus.
Radiological
plain CXR for radiologic signs
suggestive if PTB or alternative
conditions like pneumonia
24. Investigation results
Hematologic
24th Jan.
BS for MPS – no MPs seen
RFTs - urea 15.5mg/dl N
- Cr 0.181mg low
Serum electrolytes
high -[k] 6.8mmol/L
-[Na] 137mmol/L
CBC 27th Jan
-WBC 15.94x10^9
-RBC normal rang
- HB 9.0g/dl
-MCV 65.4 FL
-MCH 20.5pg
-PLT 373x10^9
Lymphocytosis 48%
Neutrophils 41%
Monocytosis ……..
25. Conti…
Radiologic
CXR – only significant
finding was Hilar
lymphadenopathy
29th Jan
Urine TB-LAM- Reactive
DBS for HIV PCR sample
taken … result to be
received after 2 weeks.
Dx
HIV exposed child with
PTB.
HIV infection highly likely
Non edematous SAM
Microcytic hypochromic
anemia ?? ACD
26. 23rd JAN
Child was admitted on ACU
Started on stabilization phase of SAM
IV D10 25 mls stat
F75 55mls every 2hrs for 24hrs then 84mls every
3hours.
IV antibiotics ampicillin + gentamicin
Rectal paracetamol q6
Oxygen therapy 2L/min by nasal prongs
Management while on ward
27. Subsequently he was started on anti TBs induction
phase HERZ + B6 x2/52 . On the basis of CXR findings
and a positive urine TB LAM (27th Jan)
We continued mgt for SAM with ITC (in patient
therapeutic care protocol.) to go on for at least 2/52
Child had spiking fever > 39C though the attendant
always reported improvement in his symptoms
Requested for a discharged on the 1st Feb , which we
advised her against as had to monitor the child on
therapy for at least 14day/or until he was stable for
Out Pt Mgt.
Follow up
28. Mother and child were not found on ward….
3rd Feb