This PDF deals with important guidelines, with respect to usage of antibiotics. This PDF outlines the important strategies involved while using antibiotics, and important factors involving antibiotic selection.
This PDF deals with important guidelines, with respect to usage of antibiotics. This PDF outlines the important strategies involved while using antibiotics, and important factors involving antibiotic selection.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
Immunosuppressant are drugs or medicines that lower the body's ability to reject a transplanted organ. Another term for these drugs is anti-rejection drugs. There are 2 types of immunosuppressants: Induction drugs: Powerful antirejection medicine used at the time of transplant.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
Immunosuppressant are drugs or medicines that lower the body's ability to reject a transplanted organ. Another term for these drugs is anti-rejection drugs. There are 2 types of immunosuppressants: Induction drugs: Powerful antirejection medicine used at the time of transplant.
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
My Powerpoint on Tuberculosis, includes:
What is the incidence and prevalence?
What are the symptoms?
How is it diagnosed?
How is it treated?
What are the treatment guidelines?
‘Experience is the best teacher”
Now, at the end of Hospital Training, I am pleading to say that NIRMA UNIVERSITY has intellectually included Hospital Training as part of B.Pharm. Hons. ‗S academic curriculum (Semester X). This hospital training has given me a chance to get exposed to practical work. What I have studied in semester 9, I have able to implement it in semester X hospital training.
I have already completed B.Pharm. And have studied subjects like Pharmaceutics, Pharmacognosy, etc. But in this course, I have been exposed to clinical field, not only theoretical aspect, but practical aspect as well which, according to me, the most exciting experience of my field is. According to my merit rank (calculated on the basis of semester 9 marks); I have got a chance to get trained in Shrey Hospital under the guidance of Dr. Chirag Joshi sir. He is the one who holds and manages the Intensive Coronary Care Unit (I.C.C.U) on one hand alone. It has been great experience to obtaining under such qualified and experienced person.
On the first day of my training, I along with fellow members was introduced to medical staff and have been introduced to different departments like ICCU, Operation theatre, dialysis unit, Radiology department, Pathology Lab, Lithotripsy, Pharmacy and various wards and these sessions were included in week one schedule.
During second week, I was allocated to pharmacy. I got exposed to the way to handle prescription and reading as well. I came to know the arrangement of medicines. Different medicines of same company were kept in one shelf and were arranged according to their alphabetical order in the same shelf. I also came to know about medication handling & storage, dispensing, ADR and medication order identification while handling prescription. By this pharmacy experience I came to know about extreme use of antibiotics i.e. irrational use we can say. Pharmacists here in pharmacy have overcome the mistakes done by doctor in hurry e.g. dose, freq.etc.
Our case studies began third week onwards and were continued till the end of training. Herein I studied different cases pertaining to most of the system of body. Dr. Chirag sir explained us the format of presenting the case like Patient demographics,chief complains, past history, past medication history, vital signs, systemic examination, laboratory investigation, other diagnostic tests (X-ray, USG, and MRI), medications, adverse reactions and then other related discussions. Sir explained us how to take history of patient and assigned me the case along with other fellow members which we have to present before him on the next day by preparing in the format what he had taught to us. Sir fully explains us the case according to format and carries on interaction as well. This include why a particular treatment is preferred (based on patient‘s economic status), how to overcome drug interactions and ADRs. He fully explains the treatment along with the available options of medicines e.g. Cephalosporins. He gives us a brief introduction over different class of the same along with brand names and the spectrum they cover. He explained all the part of case from entering in the hospital to discharge from hospital, every reason for single treatment. And I also saw some cases of particular of my interest like poisoning, alcoholic patient, renal failure.
During this practical training I also involved in ward round participation. I used to go with Chirag sir and learn the way treat the patient and maintain patient history notes. I used to check drug dose and dosing frequency. I also used to take patient history which is also critical in understanding patient‘s case. During ward round participation, I came to real practice experience as I was in front of the patient and use knowledge in dealing with patient.
All in all, it was the best experience that I have undergone in my field. This would be greater than anything in clearing my future registered pharmacist exam i
Intro to TB
epidemiology of TB
Structure of Mycobacterium TB
pathogenesis of TB
Immunosuppression by Mycobacterium TB
types of TB
Clinical manifestation
Diagnosis
Treatment
This is about tuberculosis , features, diagnosis and management. With reference to Uganda Clinical Guidelines
By Okeke Gloria, Kasule Steven, Sengooba Dennis Nyanzi
Respiratory stimulants: types, complete discussion on indications, contraindications, assessment, patient notes and examples of stimulants both central and respiratory
Expectorants and Antitussives: types, complete discussion on indications, contraindications, assessment, patient notes and examples of expectorants and antitussives
Complete pharmacology of Non steroidal Anti inflammatory Drugs, classification, Mechanism of action, Pharmacological actions, Indications, Contraindications, Adverse effects
Pharmacology laboratory experiment, both invivo and invitro includes interpolation, matching , bracketing, three point, four point bioassays with a note on hypoglycemic activity, acute skin irritation, acute eye irritaiton, pyrogen test, gastrointestinal motility test, physiological salt solutions
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
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.
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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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
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.
2. Introduction
Tuberculosis (TB) is a bacterial infection, treatable by anti- TB drugs.
The burden of TB in many countries is compounded in those who have co-
infection with the human immunodeficiency virus (HIV).
Additional concern has been the increase in multidrug- resistant tuberculosis
(MDR-TB), with outbreaks in different parts of the world.
In 2006, the emergence of extensively drug-resistant tuberculosis (XDR-TB)
was first reported.
3. Aetiology
TB is caused by tubercle bacilli, which belong to the genus Mycobacterium.
These form a large group but only three relatives (Mycobacterium tuberculosis
complex) are obligate parasites that can cause TB disease.
M. tuberculosis complex: M. tuberculosis, M. bovis, M. africanum
Mycobacteria other than tuberculosis: Around 15 are recognised as pathogenic to
humans and some cause pulmonary disease resembling TB.
They have been found in soil, milk and water (atypical mycobacteria)
Mycobacterium leprae: The cause of leprosy.
4. Clinical aspects
Infection with tubercle bacilli occurs in the vast majority of cases by the
respiratory route.
The lung lesions caused by infection commonly heal, leaving no residual
changes except occasional pulmonary or tracheobronchial lymph node
calcification
About 5% of those initially infected will develop active primary disease
lungs, lymphatic, haematogenous spread of bacilli to pulmonary, meningeal
or other extra pulmonary
5. In the other 95%, the primary lesion heals without intervention but in at least one-
half of patients, the bacilli survive in a latent form.
which may then reactivate later in life. Infants, adolescents and immunosuppressed
people are more susceptible to the more serious forms of TB such as miliary or
meningeal TB.
Sites of extra pulmonary disease include the pleura, lymph nodes, pericardium,
kidneys, meninges, bones and joints, larynx, skin, intestines, peritoneum and eyes.
6. In 2008, 55% of cases were pulmonary and 21% involved the extrathoracic lymph
nodes.
Pulmonary TB may arise from exogenous reinfection or endogenous reactivation
of a latent focus remaining from the initial infection.
If untreated, about 65% of patients will die within 5 years, the majority of these
within 2 years.
Completion of chemotherapy using drugs to which the tubercle bacilli are
sensitive almost always results in a cure, even with HIV infection.
7. Incubation period
The incubation period from infection to demonstrable primary lesion
or significant tuberculin reaction ranges from 2 to 10 weeks.
Latent infection may persist for a lifetime.
HIV infection appears to shorten the interval for the development of
clinically apparent TB.
8. Transmission
Air-borne exposure to droplet nuclei of tubercle bacilli by coughing or sneezing.
In general, only the respiratory forms of TB (tuberculosis of the larynx is highly
contagious but rarely seen ) are infectious.
Most infections are acquired from adults with post-primary pulmonary TB.
The greatest risk of infection is to close, prolonged contacts, mainly household
contacts.
Between 90% and 95% of cases of TB in children are non-infectious.
TB cannot be acquired from individuals with LTBI.
9. Smear negative/positive:
Patients should be considered infectious if they have sputum smear-positive
pulmonary disease or laryngeal TB.
Patients with smear-negative pulmonary disease (three sputum samples) are less
infectious than those who are smear positive.
The relative transmission rate from smear-negative compared with smear-positive
patients has been estimated to be 0.22
10. Risk groups
Certain groups are at increased risk of LTBI and possibly TB disease if
exposed. These include:
Close contacts of patients with TB (sputum smear-positive pulmonary)
Casual contacts (e.g. work colleagues) if they are immunosuppressed
People from countries with a high incidence of TB (40/100,000 population or greater).
People with certain medical conditions are at increased risk of developing
active TB if they have LTBI.
11. Examples of factors that increase risk of
developing TB
HIV positive
Injecting drug users
Solid organ transplantation, jejunoileal bypass or gastrectomy
Haematological malignancy, for example leukaemia and lymphomas
Chronic renal failure or receiving haemodialysis
Receiving anti-TNFα treatment
Silicosis
12. Drug-resistant TB
MDR-TB is caused by bacteria that are resistant to at least isoniazid and rifampicin,the
most effective anti-TB drugs.
MDR-TB results from either primary infection with resistant bacteria.
XDR-TB is a form of TB caused by bacteria that are resistant to isoniazid and
rifampicin, fluoroquinolone and any of the second-line anti-TB injectable drugs
including amikacin, kanamycin or capreomycin
13. Epidemiology
The key measures for TB are the number of new cases in a specified period of time,
usually 1 year, and the incidence rates, that is, new cases per 100,000 of the population.
Globally, it is estimated that TB causes about 2 million deaths worldwide each year.
One-third of the world's population is infected with the tubercle bacillus.
It is becoming the leading cause of death among HIV-positive people.
Over 4 million cases of TB disease are notified annually although the estimated number
of new cases is put at 9 million.
14. The majority of cases occur in poor countries in the southern
hemisphere
In 2008, it was estimated that 440,000 people had MDR-TB
worldwide, and one-third of these died.
The brunt of the MDR-TB epidemic is borne by Asia, with almost
50% of cases worldwide estimated to occur in China and India.
15. Symptoms
The symptoms and signs of TB include:
Cough for 3 weeks or more/productive cough
Sputum usually mucopurulent or purulent
Haemoptysis not always a feature
Fever may be associated with night sweats
Tiredness
Weight loss variable
Anorexia variable
Malaise.
16. Clinical diagnosis
The clinical diagnosis of TB disease is based on the symptoms and signs in
the patient together with chest radiography, microscopy of sputum
followed by culture and tuberculin skin testing.
Blood-based immunological tests, introduced in the last few years, will
play an increasingly important role in TB diagnosis.
These tests can distinguish between TB infection and previous BCG
vaccination.
17. Microbiological
Microbiological investigations are undertaken to assess the infectious state (mycobacteria causing
TB and other mycobacteria).
Determine the drug-susceptibility patterns of the infecting organisms, to ensure that the drugs .
Investigations comprise microscopy, culture, drug-susceptibility testing and strain typing.
Direct microscopy of sputum is the simplest and quickest method of detecting the infectious
patient, by looking for acid-fast bacilli.
A minimum of three sputum samples, one of which should be early morning, should be collected
from patients with suspected respiratory TB.
18. Cultures
Direct microscopy is not as useful in non-pulmonary disease, any specimens taken should
be sent for culture.
Lowenstein–Jensen medium, growth may take up to 6 weeks.
Polymerase chain reaction (PCR)-based tests can also detect M. tuberculosis complex in
clinical specimens.
A rapid test is available for assessing rifampicin resistance in individuals thought to have
drug-resistant TB.
A positive result indicates the need to assess susceptibility to other first line anti-TB drugs.
DNA fingerprinting, or strain typing, is useful in the public health management of TB.
New method, mycobacterial (MIRU/VNTR) 24-loci strain typing, became available in
UK
19. Tuberculin testing
Tuberculin testing is used to detect LTBI.
The standard Mantoux test consists of an intradermal injection of 2 TU of Statens Serum Institute (SSI)
tuberculin RT23 in 0.1 mL solution for injection.
In this test, 0.1 mL of the appropriate solution is injected intradermally, usually on the forearm, so that a bleb
of around 7 mm is produced.
The results are read 48–72 h later, although a valid reading can be obtained up to 96 h later.
The transverse diameter of the area of induration is measured with a ruler and the result recorded in
millimetres.
The interpretation of the test will depend on the clinical circumstances, including a past history of TB or
exposure to TB.
20. Chest radiography
The chest radiograph is a non-specific diagnostic tool, as TB may present as
virtually any abnormality on chest radiography.
This is why microbiological evidence of confirmation should be sought.
Pulmonary TB may appear as bronchopneumonia with confluent shadowing,
without cavitation.
Cavitation may be seen, the incidence can vary between 10% and 30%.
Uncharacteristic radiological patterns may occur in the presence of HIV infection .
21. Diagnosis in people with HIV
TB can occur early in the course of HIV infection and may therefore be diagnosed before
the patient is known to be HIV positive.
The possibility of HIV infection in people with TB should therefore be considered, and
testing for the virus is appropriate in those with risk factors for HIV.
Early in the course of HIV infection, before serious immunodeficiency occurs, TB is more
likely to present with typical clinical features, and a positive tuberculin skin test, with
cavitation and/or pleural disease on chest radiography.
In the late stages of HIV infection show chest findings and extra pulmonary disease.
22. Treatment
In treating TB, a number of factors are important:
• Choice of drugs
• Length of treatment
• Co-morbidity especially HIV infection, liver and renal diseases
• Adherence to treatment by the patient.
It is important to tailor the management of the patient according to his
or her situation, rather than just focus on the drug treatment of TB, as
other factors in the patient's life may affect adherence.
23. Drug treatment
Treatment with anti-TB drugs has two main purposes:
• to cure people with TB, provided the bacilli are drug sensitive
• to control TB, by either preventing the development of infectious forms
With the advent of effective anti-TB chemotherapy, patients no longer needed treatment in a sanatorium.
Results with regimens containing isoniazid together with p-aminosalicylate (PAS) or ethambutol, and sometimes
streptomycin, gave excellent results.
Treatment was required for 18–24 months if relapse was to be prevented.
The availability of pyrazinamide and, more importantly, rifampicin made shorter courses of treatment a possibility.
Most regimens in the developed world now contain isoniazid and rifampicin, which are the two most important drugs
together with pyrazinamide and possibly with another agent, such as ethambutol.
24. Bacterial characteristics
There are three populations of the M. tuberculosis (MTB) organism.
The first population is that of the actively growing extracellular bacilli (pulmonary cavities
within liquefied caseous debris)
The second population consists of slow growing or intermittently growing bacilli, which are
inside macrophages (intracellular environment )
The third population is made up of slower growing bacilli, which grow in solid caseous
material (neutral pH)
Rifampicin is the only drug that is bactericidal against all three populations.
Isoniazid, streptomycin and the other aminoglycosides are bactericidal against extracellular bacilli
25. Treatment
The recommended standard treatment regimen for respiratory and most other forms
of TB
• rifampicin, isoniazid, pyrazinamide and ethambutol for the initial 2 months
(initial phase)
• a further 4 months of rifampicin and isoniazid (continuation phase).
A longer period of treatment than the standard 6 months is needed for meningeal TB
and where there is direct spinal cord involvement.
Patients should be started on the standard treatment Regimen on clinical diagnosis.
26.
27. The purpose of the concurrent use of four drugs in the initial phase is to reduce
the bacterial population as rapidly as possible and prevent the emergence of
drug-resistant bacteria.
It is important, however, to ensure the combination product contains the required
dose of the constituent drugs.
Patients with suspected drug reactions or drug-resistant TB should always be
referred back to the specialist physician and the healthcare team supervising their
treatment.
28. Respiratory TB
Respiratory TB is defined as active TB affecting any of the following:
• lungs
• pleural cavity
• mediastinal lymph nodes
• larynx.
The standard 6-month regimen, as set out earlier, is recommended for the
treatment of active respiratory TB in:
• adults not known to be HIV positive
• adults who are HIV positive
• children.
29. TB of peripheral lymph nodes
Trials have shown that 6 months of treatment are just as effective as 9
months for fully susceptible bacilli.
The standard 6-month treatment regimen is recommended.
Meningeal TB Patients with active meningeal TB (tuberculous meningitis)
should be treated with rifampicin and isoniazid for 12 months together
with pyrazinamide, and normally ethambutol, for the first 2 months.
30. Bone and joint TB
The spine is the most common site for bone TB.
Bone and joint TB are treated effectively with standard agents such as isoniazid
and rifampicin for 6 months, together with pyrazinamide and a fourth drug,
usually ethambutol in the initial phase (for 2 months).
This recommendation covers active spinal TB and active TB at other bone and
joint sites.
Occasionally, surgery may be needed to either relieve spinal cord compression or
correct spinal deformities.
31. Pericardial TB
The standard 6-month treatment regimen is recommended for patients with
active pericardial disease.
Glucocorticoids should also be prescribed at the following doses
• Adults: a glucocorticoid equivalent to prednisolone at 60 mg/day
• Children: a glucocorticoid equivalent to prednisolone 1 mg/kg/day
(maximum 40 mg/day), with gradual withdrawal of the glucocorticoid,
starting within 2–3 weeks of initiation.