This document discusses pediatric urinary tract infections. It covers the incidence, etiology, risk factors, clinical presentation, investigations including urinalysis, urine culture and radioimaging tests, management including choice of antimicrobials and prophylaxis, prognosis, and prevention of urinary tract infections in children. The management involves treating with antibiotics based on culture results and sensitivity, with inpatient versus outpatient treatment determined by factors like age and severity of symptoms. Prognosis depends on factors like presence of renal abnormalities, with recurrence increasing risk of long term issues like renal scarring and failure.
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.
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.
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.
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.
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
This presentation covers Urinary tract Infections (UTI). Their Definition, forms, epidemiology, risk factors, etiology, Clinical manifestation, Diagnostic procedures, Management, Complications and Education to the Patients are discussed in detail.
An Obstetrics and gynecology presentation: A 20 years old single female undergraduate presents to the emergency unit with fever, lower abdominal pain and abnormal vaginal discharge of 5 days duration. Discuss her management
case presentation of hypoglycemia, Approach to hypoglycemia, pathophysiology, differential diagnosis, treatment and management, comparison and case presentation
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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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
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
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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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.
3. Cystitis
• Infection Localized to bladder
Pyelonephritis
• Infection involving the renal parenchyma, calyces and renal pelvis
Asymptomatic Bacteriuria
• Positive urine culture without any manifestations of infection
Urinary Tract Infections
4. Atypical infection:
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Failure to respond to suitable antibiotics in 48 hours
Non- E-coli infection
5. Recurrent infection:
≥2 episodes of upper UTI
or one episode of upper UTI plus ≥1 episode of lower
UTI
or ≥3 episodes of lower UTI.
6. Statistics
Gender:
Below 1 year : Boys > Girls 4 : 1
Above 1 year :Girls > Boys 10: 1
Prevalence:
By age 10 years 2% boys and 8% girls will have experienced UTI once
Recurrence:
Gender is not associated with risk of recurrence.
Risk of recurrence depends on presence of underlying abnormality
If the age of Febrile UTI is < 1 year 30% will go on to develop recurrent UTI.
7. Etiology:
Gram Stain Bacterial Organism Frequency Pre-disposition
Negative
E. Coli 75-80% Normal flora in GIT
Non- E.Coli
Klebsiella
3-5%
Genitourinary
abnormalities
Pseudomonas Indwelling catheters
Proteus Stones
Positive
Enterococcus Genitourinary
abnormalities
Staphylococcus
Saprophyticus
Normal flora in female
genital tract
12. History Of presenting
Illness
Age and Gender • Male < 1 year
• Female > 2 year
Hygiene techniques • Back to front sweep
Bowel Habits • Constipation
• Encopresis
Voiding patterns • Dysuria, frequency, urgency, incontinence
• Recurrence of enuresis
Diaper area Rash: • Incontinence
Past Medical History
• Previous undiagnosed febrile illness
• Diabetes mellitus
• Neurodegenerative disease
Birth History
• Antenatal Oligohydraminos.
• Natal LGA
• Postnatal Sequence,Malformation
Syndromes
Family history
• Recurrent UTI
• Genitourinary Abnormalities in family
14. General Examination:
Dysmorphic features
Growth Charts :
Weight: Underweight
Length: Short stature
Head circumference: Macro or microcephaly
Vital Signs
Temperature: fever >38C
BP: High
CRT: >3 sec
Systemic Examination:
GIT: Suprapubic tenderness
Cost vertebral angle tenderness
Suprapubic mass
Flank mass
Back: Tuft of hair, sacral dimple,
CNS: Features of neurodegenerative
diseases
Genitalia Local signs of irritation
Phimosis
Labial adhesions
22. Imaging Test Purpose
KUB US It is performed to exclude gross
anatomical abnormality such as
pyonephrosis, abscess and
hydronephrosis
MCUG to establish the presence and degree of
VUR
DMSA Scan It is most useful in identifying areas of
scars or decreased uptake
23. MCUG:
1. Child is catheterized
2. Radioopaque dye is instilled
3. Series of x-rays are done during
voiding
24. Tc-99m DMSA Scan:
1. Tc99m-DMSA is injected IV
2. Patient waits for 2-4 hours
3. Images are taken by gamma camera
at different views
4. Then IV Frusemide is given and another
image is taken to identify
its clearance
25.
26. NICE guidelines
Radioimaging First febrile UTI Atypical Infection Recurrent UTI
< 6
month
KUB Yes Yes Yes
DMSA - Yes Yes
MCUG If KUB abnormal Yes Yes
6 month-
3 years
KUB - Yes Yes
DMSA - Yes Yes
MCUG - Can do if KUB is showing hydronephrosis or VUR
in FH
> 3 years KUB - Yes Yes
DMSA - Yes Yes
MCUG - - -
27. Criteria to do Radioimaging:
Bottom Up approach: Renal USS followed by VCUG
Top Down approach: Renal USS and DMSA scan
28. Test Anatomy of Kidney Function of kidney Obstruction Reflux
KUB USS Yes (structural) no Identify changes as a result of
obstruction or reflux
MCUG Yes* ( structural
limited tolower ut )
no Yes * yes
DMSA Yes* ( functional ) Yes yes no
33. Inpatient vs Outpatient:
Inpatient :
< 3 months
Not tolerating oral antibiotics or
vomiting
Follow up cannot be guaranteed
Sick looking
Failed to respond to outpatient
therapy
Outpatient:
> 3 months
Tolerate antibiotics orally
Follow up can be maintained
Not Sick looking
34. Choice of Antimicrobial:
Depends on age of child
Prior pathogen isolated and its sensitivity pattern
Underlying urological abnormality and recurrence UTI
Immunosuppressed
Catheterized
35. Anti Microbials:
Latifah Hospital :
Inpatient:
Neonate: IV ampicillin +IV
Gentamycin
Other :
1st line: IV Augmentin
If penicillin allergic: IV cefuroxime
Total : 7-14 days
Uptodate:
Inpatient:
1st line: 3rd Generation
cephalosporin or
IV aminoglycoside
36. Anti Microbials:
Latifah Hospital :
Outpatient:
PO Augmentin
If penicillin allergic: PO
cefuroxime
Total : 7-14 days
Uptodate:
Outpatient:
PO cephalosporin (any
generation)
38. Prophylaxis
Indication: ( no anatomic abnormality)
Three febrile UTIs in six months
Four total UTIs in one year
Anti-Microbial :
TMP SMX
Nitrofurantoin
Duration:
6 months
Can be discontinued if no infection occurs during this period
39. Prognosis
1. If no renal abnormality prognosis is very good.
2. VUR is major determinant of renal damage, renal scar.
3. VUR grade 3 or higher are twice as likely to develop renal scar than lower
grade VUR.
4. Children with higher VUR without a UTI shown to have fewer scars than
higher grade VUR with UTI
5. Overall Risk of renal Scarring increases with young age at time of diagnosis,
delay in initiation of treatment , recurrent infections , Atypical organism.
6. 2% of history of UTI (pyelonephritis) as a primary cause go on to develop
renal insufficiency
40. Long-term Sequale of Recurrent UTI
1. Short stature
2. Poor weight gain or failure to thrive
3. Hypertension
AGE: UTI is highest in boys younger than one year and girls younger than four years
Gender: > 2years girls due to shorter urethra
Race/ethnicity — For reasons that are not completely understood, white children have a two- to fourfold higher prevalence of UTI than do black children
Genetic: On the other hand, individuals with mutations in the toll-like receptor (TLR) signaling pathway do not mount a significant inflammatory response, even when virulent bacteria are present
Bladder and bowel dysfunction — Bladder and bowel dysfunction, of which bladder dysfunction is a subset, is characterized by:
●An abnormal elimination pattern (frequent or infrequent voids, daytime wetting, urgency, infrequent stools [constipation])
●Bladder and/or bowel incontinence
●Withholding maneuvers
Bladder catheterization — The risk of UTI increases with increasing duration of bladder catheterization.
Urinary obstruction — Children with obstructive urologic abnormalities are at increased risk of developing UTI; stagnant urine is an excellent culture medium for most uropathogens. Predisposing obstructive abnormalities may be anatomic (posterior urethral valves, ureteropelvic junction obstruction), neurologic (eg, myelomeningocele with neurogenic bladder), or functional (eg, bladder and bowel dysfunction). (See appropriate topic reviews.)
YOUNG CHILD:
These findings were consistent with high rate of diagnosis of UTI in children in respective groups
The incidence was highest when Fever especially temperature> 38C for > 48 hours
UTI should always be considered part of unexplained fever in young children (AAP)
OLD CHILD:
The constellation of Fever , Chills , flank pain and CVA tenderness in older children point to Pyelonephritis
LAST:
Parental reporting of foul-smelling urine or gastrointestinal symptoms (vomiting, diarrhea, and poor feeding) is generally not helpful in diagnosing UTI
Age: Males < 1y 3-6: 1 Females: >2y 10:1
Hygiene : back to front contamination with stool pathogens Ecoli
Bowel Habits: Constipation: increases urinary stasis and thus infection
Voiding Patterns: Enuresis
Past Medical History: previous unrecognized febrile illness UTI , DM: immunodeficiency, NDD: Gaucher, Niemanpick, Leukodystrophies
Birth History:
Ante: oligohydraminos: IPKD, high ACEase ? Meningiomyelocele
Natal: oligohydraminos LGA
Post:
PUVPotter seq. Meningiomyelocele neurogenic bladder, 13, 18 ,21 Renal dysgenesis infection
FH: recurrent UTI and genitourinary abnormality PCKD , MCDK, Renal dysgenesis
GE: Potter Sequence, trisomies, turner, prune belly syndrome: Renal dysgenesis or general appearance: spasticity, para or quadriplegia signs suggestive of neurodegenerative disease neurogenic bladder
GC: FTT, Short stature, underweight Chronic or recurrent UTI Macro: leukodystrophies(white) Micro: Rett, Gaucher, nieman pick (gray)
VS: Fever: 38C points to upper UTI, BP: High inidicates renal scarring , CRT: urosepsis
Systemic Exam:
GIT: Suprapubic mass: enlarged bladder PUV , Flank mass: Hydronephrosis, renal mass ( tumor)
Back: lesion: meningiomyelocele ,Tuft of hair: occult myelocele, sacral dimple: tethered cord neurogenic bladder
CNS: features suggestive of degenerative disease :Macrocephaly Mental retardation , spasticity, para or quadriplegia
Other investigations as part of work up if child is sick looking such as CBC, Blood Culture, CRP, creatinine
Bag sample is seldom used: its only significance is when we have a negative culture( helps exclude UTI)
Mid stream urine sample: toilet trained
Sterile Catheterization: in non toilet trained
Suprapubic aspirate; seldom performed either because of lack of hands on experience or ward protocols
Microscopy : > 5 WBCS/HPF on centrifuged and unstained , not all bacterias produce pyuria and not all pyuria are UTIs
Pyuria may be less likely with certain pathogens (eg, Enterococcus species, Klebsiella species, P. aeruginosa)
LET: is basically a dipstick version to detect wbcs in urine
NT: urine must remain in the bladder for at least four hours to accumulate a detectable amount of nitrite, AND NOT ALL BACTERIA PRODUCE NITRITES, and sometimes when more than 100,000 CFU
In immunocompetenet individual we don’t do viral or fungal cultures
Viral Cultures are sometime performed in : Immunocompromised and gross hematuria with no pathogen isolated. (adenovirus, Polyomavirus, CMV)
Number of pathogens: Multiple it is contaminated
Number of CFU: according to uptodate and AAP
DMSA Dimercaptosuccinic acid
EC ethylcysteine
MCUG involves catheterization to fill the bladder with a radiopaque or radioactive liquid and recording of VUR during voiding. VCUG is expensive, invasive, and may miss a significant portion of children who are at risk for renal scarring
Can be immediately– pyelonephritis
Performed 4-6 weeks after -- scarring
Bottom up : Renal USS followed by VCUG: bladder bowel dysfunction: incomplete voiding , VUR , Bladder anamolies such as diverticula. Disadvantage is we don’t know the renal damage/condition
Top down : Renal USS and DMSA scan ; involved areas of kidney have reduced uptake, This is followed VCUG as 90% of children with dilating reflux have positive DMSA scan
MCUG:
Anatomy* delineate the anatomy of bladder and urethra
Obstruction* within the bladder and below
DMSA scan: (Localize in the cortex)
Anatomy* morphology but KUB is superior in precise measurements
>2 months : Urinary tract infection (UTI) in neonates (infants ≤30 days of age) is associated with bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT). Upper tract infections (ie, acute pyelonephritis) may result in renal parenchymal scarring and chronic kidney disease. Neonates with UTI should be evaluated for associated systemic infection, and anatomic or functional abnormalities of the kidneys and urinary tract.
Neonate it is IV ampicillin vs gentamycin
Underlying urological abnormality , immunosuppressed ; consider treating with more potent antibiotic ( 3rd generation and carbapenem)
Cathterized ( consider covering for Enterococcus and pseudomonas ) augmentin and Aminoglycoside
Uptodate: 50% of Ecoli resistant to Augmentin
Total 7-14 days ( pyelonephritis, it is shorter in case of cystitis ) and provided patient responded in 48 hours otherwise adding an antibiotic or changing antibiotic, and repeating of urine culture may be considered which may alter the duration
Uptodate: 50% of Ecoli resistant to Augmentin
Total 7-14 days ( pyelonephritis, it is shorter in case of cystitis ) ,
If no renal abnormality , even subsequent UTIs are unlikely to cause permanent renal damage.
VUR pyelonephritis Renal Scar
It is a small number Primarily because of prompt recognition and treatment of pyelonephritis.
For Reflux uropathy 5% and obstructive uropathy 16%
older children may present with short stature, poor weight gain, or hypertension secondary to renal scarring from unrecognized UTI earlier in childhood