Three key points about pneumonia:
1. Pneumonia is an acute respiratory illness caused by infection in the lungs, commonly due to bacteria like Streptococcus pneumoniae. It presents with symptoms like cough, fever, and chest pain.
2. Diagnosis involves chest x-ray and investigations to identify the causative organism. Treatment depends on severity and involves oxygen, fluids, and antibiotics. Complications can include parapneumonic effusion or empyema if not treated promptly.
3. Prevention strategies include vaccination, smoking cessation, and reducing indoor air pollution. Pneumonia remains a major global cause of death despite modern treatments.
Community Acquired Pneumonia and other types of pneumonia
for medical students
Detailed information on pneumonia including the following
Definition
Classification
Aetiology
Pathogenesis
Pathological states
Investigations
Treatment & follow up
Complications
Medication
Hospital acquired pneumonia and it’s treatment and management and prevention
Other types of pneumonia
And pneumonia in immune compromised patients
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
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
Community Acquired Pneumonia and other types of pneumonia
for medical students
Detailed information on pneumonia including the following
Definition
Classification
Aetiology
Pathogenesis
Pathological states
Investigations
Treatment & follow up
Complications
Medication
Hospital acquired pneumonia and it’s treatment and management and prevention
Other types of pneumonia
And pneumonia in immune compromised patients
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
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 characterized by the emergence of new lung infiltrates, accompanied by clinical signs such as fever, purulent sputum, leukocytosis, and decreased oxygenation and Nosocomial Pneumonia is a non-incubating lower respiratory infection that presents clinically two or more days after hospitalization. In this presentation "Nosocomial Pneumonias" has been described including their causes, therapy, Principles, diagnosis, symptoms, management, etc. For more information, please contact us: 9779030507.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Pneumonia is characterized by the emergence of new lung infiltrates, accompanied by clinical signs such as fever, purulent sputum, leukocytosis, and decreased oxygenation and Nosocomial Pneumonia is a non-incubating lower respiratory infection that presents clinically two or more days after hospitalization. In this presentation "Nosocomial Pneumonias" has been described including their causes, therapy, Principles, diagnosis, symptoms, management, etc. For more information, please contact us: 9779030507.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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
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.
2. Pneumonia
An acute respiratory illness associated with recently
developed radiological pulmonary shadowing which
may be segmental, lobar or multilobar. (or)
Inflammation in the lung characterized by accumulation
of secretions and inflammatory cells in alveoli.
3. Pneumonia remains common cause of Death
Globally Pneumonia ranked 6th
CAP is most common cause of Severe Sepsis
Despite introduction of Antibiotics, Imaging modalities
and Biomarker testing, mortalities related to CAP
has not changed significantly.
5. Pneumonia: Classifications
Clinically
Community-acquired pneumonia: (Typical/Atypical)
Onset in community or during 1st 2 days of hospitalization
(Strep. pneumoniae most common)
Hospital-acquired Pneumonia(HAP/nosocomial):
Occurring 48 hrs after hospitalization
Suppurative & Aspiration pneumonia
Pneumonia in immunocompromised patient: caused by
opportunistic organisms (Pneumocystis jirovecii).
6. Pneumonia: Classifications..
Anatomically
Lobar pneumonia if one or more lobe is involved
Broncho-pneumonia (Lobular)
1.more patchy alveolar consolidation associated
with bronchial and bronchiolar inflammation
often affecting both lower lobes
2.the pneumonic process has originated in
one or more bronchi and extends to the
surrounding lung tissue
7. Pneumonia: Classifications..
According to causes
Bacterial (the most common cause of pneumonia)
Viral pneumonia
Fungal pneumonia
Aspiration pneumonia
Chemical pneumonia (ingestion of kerosene or inhalation of
irritating substance)
9. Factors that predispose to pneumonia
Reduced host defences against bacteria
• Reduced immune defences (e.g. corticosteroid
treatment, diabetes, malignancy)
• Reduced cough reflex (e.g. post-operative)
• Disordered mucociliary clearance (e.g.
anaesthetic agents)
• Bulbar or vocal cord palsy
10. Factors that predispose to pneumonia
Aspiration of nasopharyngeal or gastric secretions
• Immobility or reduced conscious level
• Vomiting, dysphagia, achalasia or severe reflux
• Nasogastric intubation
Bacteria introduced into lower respiratory tract
• Endotracheal intubation/tracheostomy
• Infected ventilators/nebulisers/bronchoscopes
• Dental or sinus infection
12. Community-acquired pneumonia (CAP)
Acc. to BTS Guidelines CAP is defined as,
Acute lower respiratory tract infection accompanied by
new infiltrates on chest radiograph or auscultatory
findings consistent with pneumonia in a patient not
hospitalized or residing in a long term care facility for
more than 2 weeks before onset of symptoms.
13. Community-acquired pneumonia (CAP)..
Most cases are spread by droplet infection.
May occur in previously healthy individuals.
Streptococcus pneumoniae remains the most common infecting
agent.
Other organisms may be involved which depends on the age of the
patient and the clinical context.
Viral infections are important causes of CAP in children, and their
contribution to adult CAP is increasingly recognized
14. Community-acquired pneumonia (CAP)..
Mycoplasma pneumoniae is more common in young people and
rare in the elderly.
Haemophilus influenzae is more common in the elderly, particularly
when underlying lung disease is present.
Legionella pneumophila occurs in local outbreaks centred on
contaminated cooling towers in hotels, hospitals and other industrial
buildings.
Staphylococcus aureus is more common following an episode of
influenza.
15. Community-acquired pneumonia (CAP)..
Cigarette smoking
Upper respiratory tract
infections
Alcohol
Corticosteroid therapy
Old age
Recent influenza infection
Pre-existing lung disease
HIV
Indoor air pollution
Factors that predispose to pneumonia
19. RED HEPATIZATION
• Presence of erythrocytes in
the cellular intraalveolar
exudate.
• Neutrophils are also present
• Bacteria are occasionally
seen in cultures of alveolar
specimens collected
20. GRAY HEPATIZATION
• No new erythrocytes are extravasating,
and those already present have been
lysed and degraded.
• Neutrophil is the predominant cell
• Fibrin deposition is abundant
• Bacteria have disappeared
• Corresponds with successful containment
of the infection & improvement in gas
exchange
21. RESOLUTION
Macrophage is the dominant cell type in the
alveolar space.
Debris of neutrophils, bacteria, and fibrin has
been cleared.
22. Summary
Four stages:
- Congestion – Vasodilatation
– Red Hepatization – Exudation + RBC
– Gray Hepatization - Neutro & Macrophages.
– Resolution – few macrophages, normal.
24. SYMPTOMS
GENERAL SYMPTOMS ADDITIONAL SYMPTOMS
• High grade fever
• Cough-productive
• Pleuritic chest pain
• Breathlessness
• Sharp or stabbing chest pain
• Headache
• Excessive sweating and
clammy skin
• Loss of appetite and fatigue
• Confusion, especially in older
people
25. GENERAL SIGNS
• Febrile
• Tachypnoea
• Tachycardia
• Cyanosis-central
• Hypotension
• Altered sensorium
• Use of accessory muscles of respiration
• Confusion- advanced cases
29. Investigations
The aims of investigation are
Confirm the diagnosis
Exclude other conditions
Assess the severity
Identify the development of complications
Clinical diagnosis
History
Signs & symptoms
Chest x-ray
CT
Etiological diagnosis
Gram's Stain and Culture of
Sputum
Blood Cultures
Antigen Tests
Polymerase Chain Reaction
Serology
Bronchoalveolar lavage
30. Investigations..
Full blood count
Very high (> 20 × 109/L) or low (< 4 × 109/L) white cell
count: marker of severity
Neutrophil leucocytosis > 15 × 109/L: suggests bacterial
aetiology
Haemolytic anaemia: occasional complication of Mycoplasma
Erythrocyte sedimentation rate/C-reactive protein:
Non- specifically elevated
Blood culture: Bacteraemia: marker of severity
31. Investigations..
Urea and electrolytes:
Urea > 7 mmol/L (~20 mg/dL): marker of severity
Hyponatraemia: marker of severity
Liver function tests:
Abnormal if basal pneumonia inflames liver
Hypoalbuminaemia: marker of severity
Serology: Acute and convalescent titres for Mycoplasma,
Chlamydia, Legionella and viral infections
Cold agglutinins: Positive in 50% of patients with
Mycoplasma
Arterial blood gases: Measure when SaO2 < 93% or
when severe clinical features to assess ventilatory failure or
acidosis
34. Investigations..
Chest X-ray
Lobar pneumonia
Patchy opacification evolves into homogeneous consolidation
of affected lobe
Air bronchogram (air-filled bronchi appear lucent against
consolidated lung tissue) may be present.
Bronchopneumonia: Typically patchy and segmental shadowing
Complications: Para-pneumonic effusion, intrapulmonary
abscess or empyema
Staph.aureus: Suggested by multilobar shadowing, cavitation,
pneumatocoeles and abscesses
42. Management
The principles of management focusing on
Adequate oxygenation
Appropriate fluid balance
Antibiotics
In severe or prolonged illness,
Nutritional support may be required
Evaluate the effectiveness of administered medications
Explain all procedures to the patient and family
43. Management…
Oxygen
Oxygen should be administered to all patients with
tachypnoea,
hypoxaemia,
hypotension or
Acidosis
The aim of maintaining the PaO2 at or above 60mmHg
or the SaO2 at or above 92%.
44. Management….
Oxygen
High concentrations (35% or more), preferably
humidified, should be used in all patients who do not
have hypercapnia associated with COPD.
Continuous positive airway pressure (CPAP) should
be considered in those who remain hypoxic despite
this and these patients should be managed in a high-
dependency or intensive care environment, where
mechanical ventilation can be rapidly employed.
45. Management…
Intravenous fluids
These should be considered in patients with severe
illness, older patients and those who are vomiting.
Otherwise, an adequate oral intake of fluid should be
encouraged.
Inotropic support may be required in patients with
shock
46. Management…
Antibiotics
Prompt administration of antibiotics improves the outcome.
The initial choice of antibiotic is guided by
clinical context,
severity assessment,
local knowledge of antibiotic resistance patterns
any available epidemiological information.
The choice of empirical antibiotic therapy is considerably more
challenging, due to
Diversity of pathogens
Drug resistance.
47. Management…
Uncomplicated CAP:
Outpatient Treatment (empirical)
Previously healthy and no antibiotics in past 3 months
* A macrolide (clarithromycin or azithromycin or Doxycycline )
Comorbidities or antibiotics inpast 3 months:
Respiratory fluoroquinolone [moxifloxacin ,levofloxacin ]or
β- lactam ( high-dose amoxicillin or amoxicillin/clavulanate)
48. Management…
Inpatient Treatment- Non ICU:
•A respiratory fluoroquinolone [moxifloxacin ,levofloxacin ]
•β -lactam [cefotaxime ,ceftriaxone ,ampicillin] plus a
macrolide [oral clarithromycin or azithromycin)
Inpatient Treatment- ICU:
•β -lactam plus Azithromycin or a fluoroquinolone
49. Management…
Pseudomonas:
MRSA
• If MRSA, add linezolid or vancomycin
• An antipneumococcal, antipseudomonal β-lactam
[piperacillin/tazobactam, cefepime , imipenem ,
meropenemplus flouroquinolones]
• Above β-lactams plus an aminoglycoside and azithromycin
• Above β-lactams plus an aminoglycoside plus
an antipneumococcal fluoroquinolone
50. Management…
Pain
It is important to relieve pleural pain, as it may prevent the
patient from breathing normally and coughing efficiently.
For the majority, simple analgesia with paracetamol, co-codamol
or NSAIDs is sufficient.
In some patients, opiates may be required but these must be
used with extreme caution in patients with poor respiratory
function, as they may suppress ventilation.
Physiotherapy
May help expectoration in those who suppress cough because of
pleural pain.
52. Preventive measures
Current smokers should be advised to stop smoking
Influenza Vaccine & Pneumococcal Vaccine should be
considered in selected pts
In developing countries, tackling malnutrition & Indoor air
pollution
Immunization against measles, pertussis & Haemophillus
influenzae type b in children
Legionella pneumophila has important public health
implications and usually requires notification to the
appropriate health authority.