A previously healthy 32-year-old male presented with a 2-day history of fever, chills, productive cough, dyspnea, and chest pain. On examination, he had tachycardia, tachypnea, and reduced breath sounds with crackles on the left side of his chest. He likely has pneumonia based on his symptoms and physical exam findings of reduced breath sounds and crackles.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
a double-stranded DNA virus : human herpesvirus-3 subfamily Alphaherpersvirinae
only one serotype is known
humans are the only reservoir
VZV enters the host through the nasopharyngeal mucosa, and almost invariably produces clinical disease in susceptible individuals
Following varicella, the virus persists in sensory nerve ganglia, from where it may later be reactivated to cause herpes zoster (Shingles)
Use of Sputum sample for diagnosis of disease, interpretation, treatment & cl...narmeenarshad
Sputum Sample
Sputum is mucus that is coughed up from the lower airways.In medicine, sputum samples are usually used for microbiological investigations of respiratory infections and cytological investigation of respiratory systems.
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
a double-stranded DNA virus : human herpesvirus-3 subfamily Alphaherpersvirinae
only one serotype is known
humans are the only reservoir
VZV enters the host through the nasopharyngeal mucosa, and almost invariably produces clinical disease in susceptible individuals
Following varicella, the virus persists in sensory nerve ganglia, from where it may later be reactivated to cause herpes zoster (Shingles)
Use of Sputum sample for diagnosis of disease, interpretation, treatment & cl...narmeenarshad
Sputum Sample
Sputum is mucus that is coughed up from the lower airways.In medicine, sputum samples are usually used for microbiological investigations of respiratory infections and cytological investigation of respiratory systems.
PATHOGENESIS OF BRONCHIECTASIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MED...Prof Dr Bashir Ahmed Dar
Dr Bashir Ahmed Dar associate professor medicine chinkipora sopore kashmir presently working in malaysia speaks about bronchiectasis.Bronchiectasis which is defined as the irreversible dilatation of the cartilage-containing airways bronchi or bronchioles.
The Top Skills That Can Get You Hired in 2017LinkedIn
We analyzed all the recruiting activity on LinkedIn this year and identified the Top Skills employers seek. Starting Oct 24, learn these skills and much more for free during the Week of Learning.
#AlwaysBeLearning https://learning.linkedin.com/week-of-learning
updated info from reliable source .
it helps in understanding complications due to covid . it is handy for interns and postgraduates to act when cases come ,
Manejo en Atención Primaria de la Neumonía Adquirida en la Comunidad.RafaTamarit2
El pasado martes 30 de marzo, nuestro compañero Víctor Espuig, residente de tercer año de medicina familiar y comunitaria de nuestro centro de salud, nos recordaba, en nuestra sesión de los martes, los principales aspectos de la neumonía adquirida en la comunidad.
La neumonía adquirida en la comunidad (NAC) es una causa importante de morbilidad y mortalidad a nivel mundial (primera causa de muerte por infección en países desarrollados).
La presentación clínica de la NAC varía desde una neumonía leve caracterizada por fiebre y tos productiva a una neumonía severa caracterizada por distrés respiratorio y sepsis. Consecuencia de este amplio abanico clínico, la NAC forma parte de un gran grupo de enfermedades respiratorias a tener en cuenta en el diagnóstico diferencial.
En esta presentación encontrarás una visión general sobre la epidemiología (incidencia y factores de riesgo), la microbiología (patógenos más frecuentes), el diagnóstico y diagnóstico diferencial, los criterios de remisión al medio hospitalario, el tratamiento (selección de antibioterapia) y las medidas preventivas más importantes de la NAC en el paciente adulto inmunocompetente en el ámbito de la atención primaria.
Mensajes para llevar a casa:
− El diagnóstico en atención primaria es clínico-radiológico, sin necesidad de tener un diagnóstico etiológico a través del estudio microbiológico.
− Conocer las escalas pronósticas como apoyo al juicio clínico.
− Seleccionar tratamiento antibiótico empírico en función de las circunstancias descritas para cada paciente (quinolonas nunca primera elección).
− Mantener antibioterapia un mínimo de 5 días; prolongar a 7-10 días en caso de persistencia de fiebre.
− Si no hay mejoría del cuadro clínico en 48-72 horas reconsiderar el diagnóstico y el tratamiento empírico, así como las posibles complicaciones.
− No repetir Rx de tórax si el cuadro clínico se resuelve en menos de 7 días.
− Conocer y aplicar las medidas de prevención más importantes.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
1. Case 1
• A previously healthy male, 32 had a running nose
since last week presented with a 2-day history of
fever, shaking chills (rigors), cough productive of
rusty sputum, dyspnea, and chest pain getting worse
with deep inspiration.
• O/E Pt is alert, Vitals :T 39°C, HR 110, RR 25, BP
110/80. SaO2 is 92%.
• He has reduced tactile fremitus, dullness to
percussion, bronchial breath sounds and crackles at
left 6-9 rib-interspaces posteriorly.
2-Nov-12
4. Definition
“ACUTE RESPIRATORY ILLNESS ASSOCIATED
WITH PYREXIA AND COUGH, AND
RECENTLY DEVELOPED RADIOGRAPHIC
SIGNS OF CONSOLIDATION OF A PART OR
PARTS OF ONE OR BOTH LUNGS”
• The commonest infectious cause of death
• Most of mortality at extremes of ages
• Most cases are treatable if diagnosed and
treated with appropriate antibiotics
2-Nov-12
8. Case 1
• A previously healthy male, 32 had a running nose
since last week presented with a 2-day history of
fever, shaking chills (rigors), cough productive of
rusty sputum, dyspnea, and chest pain getting worse
with deep inspiration.
• O/E Pt is alert, Vitals :T 39°C, HR 110, RR 25, BP
110/80 SaO2 is 92%.
• He has reduced tactile fremitus, dullness to
percussion, bronchial breath sounds and crackles at
left 6-9 rib-interspaces posteriorly.
2-Nov-12
9. Classification of pneumonias
• BRONCHO-pneumonia
• LOBAR pneumonia
• SEGMENTAL pneumonia
• SUBSEGMENTAL pneumonia
And
‘Double’ pneumonia
2-Nov-12
14. Classification of pneumonias
• Hospital-acquired (or nosocomial) pneumonia (HAP) is
pneumonia that occurs 48 hours or more after admission and
did not appear to be incubating at the time of admission.
• Ventilator-associated pneumonia (VAP) is a type of HAP
that develops more than 48 to 72 hours after endotracheal
intubation.
• Healthcare-associated pneumonia (HCAP) is defined as
pneumonia that occurs in a non-hospitalized patient with
extensive healthcare contact, as defined by one or more of the
following:
o Hospitalization in an acute care hospital for two or more days
within the prior 90 days
o Intravenous therapy, wound care, or intravenous chemotherapy
within the prior 30 days
o Attendance at a hospital or hemodialysis clinic within the prior 30
days
o Residence in a nursing home or other long-term 2-Nov-12
care facility
16. CAP - Presentation
Typical CAP Atypical CAP
an abrupt onset, a progressive onset,
high fever, chills, fever without chills,
productive cough, dry cough,
thoracic pain, headache, myalgia,
focal clinical signs, diffuse crackles,
lobar or segmental interstitial infiltrates on chest
radiographic findings, radiograph,
leukocytosis, and modest leukocytosis,
sputum Gram stain that is sputum Gram stain (and
positive for possibly culture) that is
bacteria, frequently of a negative for bacteria
single predominant type. Mostly due to intracellular
Mostly due to extracellular bacteria or to viruses.
bacteria such as S.
pneumoniae, Staph
aureus, and H. influenzae. 2-Nov-12
17. Other Pneumonias - Microbiology
What are the differences?
HAP, VAP, and HCAP may be caused by
• Specific pathogens and can be polymicrobial.
• Common pathogens include
• Aerobic gram-negative bacilli (eg, Escherichia coli,
Klebsiella pneumoniae, Pseudomonas aeruginosa,
Enterobacter spp, Acinetobacter spp)
• Gram-positive cocci (eg, Staphylococcus aureus,
including MRSA, Streptococcus spp).
• Viruses or fungi are significantly less common
• Organisms may be multi-drug resistant
2-Nov-12
18. Case 2
• A heavy smoker bank accountant of 46 years
presented with high grade fever, worsening cough,
little rusty sputum production and Rt pleuritic chest
pain after a visit to Skardu two days ago (in the
month of January).
• O/E confused, RR 36/min, T 102 OF, P 110/min, BP
80/60, Hb 16.8 g/dl, TLC 18000 (88% N), Urea 32
mg/dl (5.3 mmol/L) Sputum Smear showed Gram
Positive diplococci
2-Nov-12
20. Streptococcus pneumoniae are Gram-positive, lancet-shaped cocci in
couples
Streptococcus pneumoniae
A mucoid strain on blood agar
showing alpha hemolysis (green
zone surrounding colonies). Note
the zone of inhibition around a
filter paper disc impregnated with
optochin. Viridans streptococci
are not inhibited by optochin.
2-Nov-12
22. Case 3
• An 18 years old previously healthy medical student
living in college hostel developed worsening dry
cough with high grade pyrexia for three days. Two
days ago he developed severe pain in Rt ear.
• O/E Alert, Mildly Jaundiced, P: 120/min RR:32/min, T
101OF, BP: 110/80
• Labs: Hb 13.4, TLC 8800, Normal Dif. S Bil 2.5
mg/dl ALT 34 iu/L, Urea 4 mmol/L
2-Nov-12
28. Case 4
• Male, 60, admitted to hospital with 2-wk H/O
myalgia, headache, dyspnoea and cough without
sputum.
• O/E severely ill, cyanosed and delirious with
T:39°C; P:110/min, RR:40/min and
BP:110/60mmHg. PO2:43mmHg,
PCO2:37mmHg, TLC 4600/cumm and urea 4
mmol/L.
• He had received amoxicillin for 6 days before
admission without improvement. CXR shows
extensive bilateral multilobar consolidation. He
kept birds as a hobby and one of his budgerigars
2-Nov-12
29. The clinical
diagnosis of
psittacosis was
subsequently
confirmed by
serology tests. He
was treated with
intravenous
fluids, oxygen and
tetracycline and
recovered fully
2-Nov-12
30. CT scan of the chest demonstrates patchy multifocal ground glass
attenuation opacities (arrows).
2-Nov-12
31. Case 5
65-year-old female presented with acute respiratory
failure. She had been sick for two weeks with fever,
confusion, diarrhea, cough, and purulent sputum
production. Her medical checkup two months ago
was unremarkable.
Urea 11 mmol/L, Creatinine 3.2
CXR and later CT chest obtained
2-Nov-12
34. Investigations in CAP
ROUTINE INVESTIGATIONS IN CAP
• Chest X-ray +/- CT chest
• Blood: CBC with reticulocytes
• Tests for microbiological identification:
2-Nov-12
36. Approach to a patient with CAP
History Examination Chest x-ray
PNEUMONIA
diagnosed
CLUES TO LIKELY
PATHOGEN
•Environmental clues •Bird or animal contact
•Season •Immunosuppression?
•Recent hotel stay •Co-morbidity
•Current epidemic •Age
2-Nov-12
37. Case 6
A 34-year-old woman is admitted with a history of
fever, chills, and reddish sputum like red currant
jelly for 10 days. She is on pulse steroid therapy
for lupus nephritis.
On physical examination, pulse 113 bpm;
temperature 101°F; respirations 35/min; blood
pressure 110/78 mm Hg. She looks ill and has
crackles in the right upper lung field.
Lab data: Hb 12 g/dL; WBCs 25.0/μL; N 92%
BUN 8 mmol/L; creatinine 1.7 mg/dL
2-Nov-12
41. Klebsiella pneumonia. Downward bulging of the minor fissure (arrow)
due to massive enlargement of the right upper lobe with inflammatory
exudate.
2-Nov-12
42. Case 7
• Male, 65, known diabetic with h/o 30 cpy
presents with a 4-day history of productive cough
with greenish sputum and shortness of breath.
He has left-sided chest pain that is worse with
deep inspiration and complained of fever and
chills on the day of admission.
• On physical exam, he has a temperature of
103°F; pulse 120 bpm; respirations 32/min; BP
100/68.
• Lungs: increased tactile vocal fremitus with
bronchial breath sounds on the left side
posteriorly. 2-Nov-12
46. Case 8
A 53-year-old man with a bone marrow transplant
presented with one month hitory of dry cough and
low grade pyrexia. CXR and CT scan show bilateral
dense airspace and ground-glass opacities
associated with airway dilatation. The distribution is
predominantly central and upper lung.
2-Nov-12
48. PCP pneumonia in a young HIV- CT scan of the chest demonstrates
positive patient. cystic air spaces of varying sizes that
CXR demonstrates are consistent with pneumatoceles.
predominantly central airspace
disease with peripheral sparing.
2-Nov-12
49. Pneumonia in the
immunocompromised host
Mechanism Cause Organisms
Marrow Aplasia Staph. aureus
Neutropenia AMM Gram negative bacteria
Marrow infiltration Candida/ Aspergillus
AIDS Strept. pneumoniae
T cell defect CLL H. influinzae
Lymphoma Staph. aureus
Immunosuppressants Gram negative bacteria
BMT Pneumocystis carinii
Splenectomy Myco. tuberculosis
CLL Strept. pneumoniae
Antibody Myeloma H. influinzae
production
2-Nov-12
50. Case 9
A 56-year-old male non-smoker is admitted with
shortness of breath, right sided chest pain, and
productive cough. He has a history of seizure
disorder and is on anticonvulsants. Phenytoin
level is within therapeutic range.
On examination, there is dullness to percussion
in the right upper chest with decreased breath
sounds. Sputum for AFB and fungi are negative
on initial smear and cultures are pending.
2-Nov-12
52. Case 10
A 29-year-old man is admitted with cough, rusty
sputum production, fever, chills, and decreased
O2 saturation.
His chest x-ray shows a right upper lobe
nonhomogeneous opacity. He is treated with IV
antibiotics but does not improve. On the fifth
hospital day, CXR is repeated
2-Nov-12
PA film showing consolidated right upper lobe. Lateral film showing consolidation limited inferiorly by horizontal fissure (arrows).
Mycoplasmal pneumonia. “Classic” homogeneous consolidation of the right middle lobe caused by a serologically confirmed infection of Mycoplasma pneumoniae.PA film showing right middle-lobe pneumonia: note obscured cardiac border adjacent to the consolidation. Lateral view showing consolidation demarcated by horizontal and oblique fissures.
Legionella
A, Legionellosis, initial chest radiograph showing left lower lobe consolidation.B, Legionellosis, initial chest computed tomography demonstrates left lower lobe alveolar infiltrate and pleural effusion.
B, Legionellosis, initial chest computed tomography demonstrates left lower lobe alveolar infiltrate and pleural effusion. C, Legionellosis, chest computed tomography performed 6 weeks later (and after a 3-week course of macrolide) demonstrates partial resolution of left lower lobe alveolar infiltrate and disappearance of parapneumonicpleural effusion.
This x-ray shows a large lobar density in the right upper lobe with some area of incomplete consolidation in the density. The lower end of this opacity is bulging and the horizontal fissure is displaced downward.The lateral confirms large right upper lobe pneumonia with a bulging fissure seen in a densely consolidated lobe due to klebsiella pneumonia.
PA chest radiograph shows bilateral interstitial and alveolar opacities with an upper lung predominant distribution.