Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness. There are two main types of bronchitis: acute and chronic.
Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness. There are two main types of bronchitis: acute and chronic.
Dr. Md. Khairul Hassan Jessy
Associate Professor, Respiratory Medicine
National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka.
Acknowledment:
Davidson’s Principles and Practice of Medicine
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 inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
Dr. Md. Khairul Hassan Jessy
Associate Professor, Respiratory Medicine
National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka.
Acknowledment:
Davidson’s Principles and Practice of Medicine
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 inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
PNEUMONIA,
DEFINITION
Pneumonia is an infection of the pulmonary parenchyma.
To the pathologist, pneumonia is an infection of the alveoli ,distal airways, and interstitium of the lung that is manifested by increased weight of the lungs, replacement of normal lung’s sponginess by consolidation ,and alveoli filled with white blood cells ,red blood cells and fibrin .To the clinician, pneumonia is a constellation of symptoms and signs in combination with at least one opacity on CXR.
Epidemiology
Between 5 and 10 million cases of infectious pneumonia occur annually in the United States and result in more than 1 million hospitalizations.
Pneumonia is a leading cause of death worldwide, the sixth leading cause of death in the United States, and the most common lethal infectious disease.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
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Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
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What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Comparing Evolved Extractive Text Summary Scores of Bidirectional Encoder Rep...University of Maribor
Slides from:
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
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https://www.etran.rs/2024/en/home-english/
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In this book, we use conservation of energy techniques on a fluid element to derive the Modified Bernoulli equation of flow with viscous or friction effects. We derive the general equation of flow/ velocity and then from this we derive the Pouiselle flow equation, the transition flow equation and the turbulent flow equation. In the situations where there are no viscous effects , the equation reduces to the Bernoulli equation. From experimental results, we are able to include other terms in the Bernoulli equation. We also look at cases where pressure gradients exist. We use the Modified Bernoulli equation to derive equations of flow rate for pipes of different cross sectional areas connected together. We also extend our techniques of energy conservation to a sphere falling in a viscous medium under the effect of gravity. We demonstrate Stokes equation of terminal velocity and turbulent flow equation. We look at a way of calculating the time taken for a body to fall in a viscous medium. We also look at the general equation of terminal velocity.
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I Introduction
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V Virtual Revelation: The Unity of Theology
VI Theology as a Natural Science
VII Theology’s Certitude
VIII Conclusion
Notes
Bibliography
All the contents are fully attributable to the author, Doctor Victor Salas. Should you wish to get this text republished, get in touch with the author or the editorial committee of the Studia Poinsotiana. Insofar as possible, we will be happy to broker your contact.
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Heavy metals are naturally occuring metallic chemical elements that have relatively high density, and are toxic at even low concentrations. All toxic metals are termed as heavy metals irrespective of their atomic mass and density, eg. arsenic, lead, mercury, cadmium, thallium, chromium, etc.
2. Is an inflammation of the lung parenchyma that
is caused by a microbial agent.
• Pneumonia is a more general term that
describes an inflammation process in the
lung tissue.
• Bacteria commonly enter the lower airway
but do not cause pneumonia in the presence
of an intact host defense mechanism.
5. Community acquired pneumonia
CAP
Occur in community within 48 hr. of hosp. or
institutionalization.
• Causative agent is S. pneumonia, H. influienza.
• S.pneumonia is the most common CAP in people older than
60. Most common during winter & spring. Its gram +ve
capsulated non motile that resides in URT. It may occur as
lobar or bronchopneumonia.
6. Community acquired pneumonia
CAP
Mycoplasma pneumonia: most often in older children &
young adult, spread by infected respiratory droplets
through person to person contact. Occur as
bronchopneumonia.
H.influinza: affects elderly or those with comorbid illness
as COPD. X-ray multi lobar, bronchopneumonia, or areas
of “consolidation” tissue that solidifies as a result of
collapsed alveoli or pneumonia.
7.
8. Community acquired pneumonia
CAP
Viruses: viral pneumonia in immmunocompetent children areViruses: viral pneumonia in immmunocompetent children are
influenza viruses type A, B, adenovirus, parainfluinza virus,influenza viruses type A, B, adenovirus, parainfluinza virus,
varicella zoster.varicella zoster.
Immunocompremized adult, cytomegalovirus, herpes simplex,Immunocompremized adult, cytomegalovirus, herpes simplex,
adenovirus, RSV.adenovirus, RSV.
Acute stage of viral respiratory infection occurs withinAcute stage of viral respiratory infection occurs within
ciliated cell of the airways.ciliated cell of the airways.
Infiltration of tracheabroncheal tree with pneumonia.Infiltration of tracheabroncheal tree with pneumonia.
The inflammatory process extends to alveolar areaThe inflammatory process extends to alveolar area
9. Hospital acquired pneumonia
Knows as nosocomial is defining as the onset of pneumonia
symptoms more than 48 hr.s after admission to hospital.
Its accounts for approximately 15% of hospital acquired
infections.
The common organisms include: Enterobacter species,
Klebsiella apecies, P.aeruginosa, Protus, methicillin resistant
S.aureus (MRSA).
10. Hospital acquired pneumonia
Certain illness may predispose pt HAP because
of:
• Impaired defenses or chronic illness; Coma,
malnutrition, prolong, hospitalization.
• Numerous intervention as endotracheal intubation,
NGT.
• Immunocompromised pt, gram –ve bacilli,
staphylococcal pneumonia responsible for more
than 30% of cases of HAP. Its mortality is high,
resistant to all antimicrobial except vancomycin.
These strains of s.aureus are refered to as MRSA.
11. Hospital acquired pneumonia
• Because methicillin resistant S. aureus (MRSA is highly
virulent, steps must be taken to prevent spread . pt must be
isolated with contact precautions.
HAP is presented with pulmonary infiltration on chest x-ray
combined with evidence of infection as fever, purulent
sputum & leukocytosis.
Pneumonia from klebseilla or gram–ve, e.g (E.coli,) are
characterized by destruction of lung structure & alveolar
walls, consodilation & bacteremia
12. Clinical manifestationsClinical manifestations
• A sudden onset of cough
• Blood-tinged sputum may be present.
• In the debilitated or dehydrated patient, sputum production
may be minimal or absent
• Pleural effusions
• High fever
• tachycardia
• Even with treatment, the mortality rate remains high.
13. Pneumonia in the compromisedPneumonia in the compromised
hosthost
• May be caused by the organisms
• (S. pneumoniae, S. aureus, H. influenzae, P. aeruginosa, M.
tuberculosis).
Clinical presentation:
1. Dyspnea
2. Fever
3. Nonproductive cough.
14. Immuno-compromised statesImmuno-compromised states
• Pt. use corticosteroids or other
immunosuppressive agents
• Chemotherapy
• Nutritional depletion
• Use of broad-spectrum antimicrobial agents
• AIDS
• Genetic immune disorders
• Long-term advanced life-support technology
(mechanical ventilation).
15. Aspiration pneumoniaAspiration pneumonia
• Refers to the pulmonary consequences resulting
from the entry of endogenous or exogenous
substances into the lower airway.
• The most common form of aspiration pneumonia is
bacterial infection from aspiration of bacteria that
normally reside in the upper airways
16. Setting of Aspiration pneumoniaSetting of Aspiration pneumonia
• May occur in the community or hospital;
common pathogens are S. pneumoniae, H. influenzae, and S.
aureus.
Other substances may be aspirated into the lung, such as;
1. Gastric contents
2. Exogenous chemical contents
3. Irritating gases.
This type of aspiration or ingestion may impair the lung
defenses, cause inflammatory changes, and lead to bacterial
growth and a resulting pneumonia.
17. • Distribution of lung
involvement in bronchial and
lobar pneumonia.
• In bronchopneumonia (left),
patchy areas of consolidation
occur.
• In lobar pneumonia (right), an
entire lobe is consolidated
18. Pathophysiology
• Upper airway characteristics normally prevent potentially infectious
particles from reaching the normally sterile lower respiratory tract.
• Thus, patients with pneumonia caused by infectious agents often have an
acute or chronic underlying disease that impairs host defenses.
• Pneumonia arises from normally present flora in a patient whose
resistance has been altered, or it results from aspiration of flora present in
the oropharynx.
• It may also result from blood borne organisms that enter the pulmonary
circulation and are trapped in the pulmonary capillary bed, becoming a
potential source of pneumonia.
19. Pathophysiology
• Pneumonia often affects both ventilation and diffusion.
• An inflammatory reaction can occur in the alveoli, producing
an exudate that interferes with the diffusion of oxygen and
carbon dioxide.
• White blood cells, mostly neutrophils, also migrate into the
alveoli and fill the normally air-containing spaces.
• Areas of the lung are not adequately ventilated because of
secretions and mucosal edema that cause partial occlusion of
the bronchi or alveoli, with a resultant decrease in alveolar
oxygen tension.
20. Pathophysiology
• Broncho spasm may also occur in patients with reactive
airway disease. Because of hypoventilation, a ventilation–
perfusion mismatch occurs in the affected area of the lung.
• Venous blood entering the pulmonary circulation passes
through the under ventilated area and exits to the left side of
the heart poorly oxygenated.
• The mixing of oxygenated and unoxygenated or poorly
oxygenated blood eventually results in arterial hypoxemia.
21. Pathophysiology
• If a substantial portion of one or more lobes is involved, the
disease is referred to as “lobar pneumonia.”
• The term “bronchopneumonia” is used to describe pneumonia
that is distributed in a patchy fashion, having originated in
one or more localized areas within the bronchi and extending
to the adjacent surrounding lung parenchyma
• Bronchopneumonia is more common than lobar pneumonia
22. Risk FactorRisk Factor
• Conditions that produce mucus or bronchial obstruction and
interfere with normal lung drainage (eg, cancer, cigarette
smoking, COPD)
• Immuno suppressed patients and those with a low neutrophil
count (neutropenic)
• Smoking; cigarette smoke disrupts both mucociliary and
macrophage activity
• Prolonged immobility and shallow breathing pattern
23. Risk FactorRisk Factor
• Depressed cough reflex;
1. Due to medications
2. A debilitated state
3. Weak respiratory muscles
• Aspiration of foreign material into the lungs during a period of
unconsciousness;
1. head injury
2. Anesthesia
3. depressed level of consciousness
• Abnormal swallowing mechanism
• Nothing-by-mouth (NPO) status; placement of nasogastric, orogastric,
or endotracheal tube
24. • Antibiotic therapy (in very ill people, the oropharynx is likely to
be colonized by gram-negative bacteria)
• Alcohol intoxication (because alcohol suppresses the body’s
reflexes, may be associated with aspiration, and decreases white
cell mobilization and tracheobronchial ciliary motion)
• General anesthetic, sedative, or opioid
• Advanced age, because of possible depressed cough and glottic
reflexes and nutritional depletion
• Respiratory therapy with improperly cleaned equipment
25. Preventive MeasurePreventive Measure
• Promote coughing and expectoration of secretions.
• Encourage smoking cessation.
• Initiate special precautions against infection.
• Reposition frequently and promote lung expansion exercises
• Initiate suctioning and chest physical therapy if indicated.
26. Preventive MeasurePreventive Measure
• Promote frequent oral hygiene.
• Minimize risk for aspiration by checking placement of tube
and proper positioning of patient.
• Encourage reduced or moderate alcohol intake (in case of
alcohol stupor, position patient to prevent aspiration).
• Observe the respiratory rate and depth during recovery from
general anesthesia and before giving medications.
• If respiratory depression is apparent, with hold the medication
and contact the physician.
27. 3 specific strategies for preventing
HAP
• Staff education & infection surveillance.
• Interruption of transmission of microorganisms
• Modification of host risk of infection.
Vaccination against pneumococcal infection is advised for:
People over 65 years.
Immunocompetent people.
People with functional & anatomic asplenia.
People living in environments or social setting in which
risk of disease is high.
28. Clinical Manifestations
• Sudden onset of shaking chills, rapidly
rising fever, pleuritic chest pain by deep
breathing and coughing.
• Respiratory distress (shortness of breath,
use of accessory muscles in respiration)
• Increase pulse and tachypnea
• URTIURTI
• In sever pneumonia, flushed cheeks, lipsIn sever pneumonia, flushed cheeks, lips
and nail beds- central cyanosis.and nail beds- central cyanosis.
• Orthopnea.Orthopnea.
• Poor appetitePoor appetite
• Purulent SputumPurulent Sputum
29. DX finding & assessment
1. History, physical examination.
2. Chest x-ray
3. Blood culture (bacteremia)
4. Sputum examination.
5. Bronchoscopy is often used with pt. with acute sever
infection or immuno-compromized pt.
30. Obtaining sputum sampleObtaining sputum sample
(1) Rinse the pt.s mouth with water to
minimize contamination by normal oral
flora
(2) Breathe deeply several times
(3) Cough deeply
(4) Expectorate the raised sputum into a sterile
container.
31. Medical Management
• Administration of appropriate antibiotic as result of gram
stain.
• Rx for out pt with CAP who has no cardiopulmonary disease
(CPD), includes, erythromycin
• If pt have CPD, high dose amoxicillin or augmentim.
• (HAP), or nosocomial pneumonia, empirical treatment- broad
spectrum IV antibiotics.
32. Medical Management
Treatment for viral pneumonia is supportive, antibiotics used
with viral infection when secondary bacterial pneumonia,
bronchitis or sinusitis are presented.
Antipyretic, to treat headache, fever
Antitussive, cough.
Warm moist inhalation, to relieve bronchial irritation
Anti histamine, to reduce sneezing & rhinorrhea.
33. Medical Management
If hypoxemia, O2 supply, blood gases, pulse
oximetry. High o2 is contraindicated in
COPD. Because may worsen alveolar
ventilation by decreasing pt. ventilatory
drive.
Respiratory support measure include, high
O2 concentration, endotracheal intubation,
mechanical ventilation.
To prevent serious complication in elderly,
vaccination against pneumococcal &
influenza infection is recommended.