This document provides information on pyrexia of unknown origin (PUO). It defines PUO as a temperature greater than 101°F on multiple occasions for more than 3 weeks without a diagnosis. Common causes discussed include infections (such as tuberculosis, endocarditis, and abscesses), cancers, and autoimmune disorders. The document outlines approaches to evaluating a patient with PUO, including taking a thorough history, conducting a physical exam, and performing staged laboratory investigations and imaging studies. It emphasizes starting with basic tests before moving to more invasive studies. The document also discusses indications for immediate empirical antibiotic therapy versus continued observation and targeted therapy based on diagnostic clues.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules.[1] In addition to providing a scaffolding support for the tubular architecture, the interstitium has been shown to participate in the fluid and electrolyte exchange as well as endocrine functions of the kidney.[1] There are a variety of known factors that can provoke the inflammatory process within the renal interstitium, including pharmacologic, environmental, infectious and systemic disease contributors. The spectrum of disease presentation can range from an acute process to a chronic condition with progressive tubular cell damage and renal dysfunction.
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules.[1] In addition to providing a scaffolding support for the tubular architecture, the interstitium has been shown to participate in the fluid and electrolyte exchange as well as endocrine functions of the kidney.[1] There are a variety of known factors that can provoke the inflammatory process within the renal interstitium, including pharmacologic, environmental, infectious and systemic disease contributors. The spectrum of disease presentation can range from an acute process to a chronic condition with progressive tubular cell damage and renal dysfunction.
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
Adult-onset Still's disease is a form of rheumatoid arthritis that was characterized by Bywaters in 1971. Its main feature is a combination of symptoms such as high fever, cutaneous rash during fever peaks, joint and muscle pain, lymph node enlargement, increased white cell count especially polymorphonuclear neutrophils and abnormalities of liver metabolism. None of these symptoms is sufficient to establish the diagnosis and infact may be present in several other diseases such as neoplastic and infectious diseases. Thus AOSD is a “diagnosis of exclusion”.
Still's disease, sometimes referred to as Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash.
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
Emergency Department Evaluation and Management of the Febrile TravelerJoseph Reardon
This presentation, intended for emergency medicine residents, covers the evaluation and management of four common causes of fever in the international traveler: malaria, typhoid, dengue and chikungunya.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
3. Regulates normal body temperature
Normal Rectal temp. being
97.7-99.5°F
Oral temp. being 0.7°F
lower than rectal
while axillary being 1.2°F
lower than rectal.
Daily normal variation
being 0.5-1°F
With evening temperatures
being higher than the
morning
If body temp. exceeds
normal variation in an
individual, that’s called
FEVER
4. Liebermiester’s Rule: With each degree centigrade
rise in body temp. , heart rate increase by 8 per min
Except in those diseases where relative bradycardia
sets in.
6. DURACK & STREET’S CLASSIFICATION
CLASSIC
PUO
• 3 OUTPATIENT VISITS OR 3 DAYS IN HOSPITAL W/O ELUCIDATION OF CAUSE
• OR 1 WEEK OF “INTELLIGENT AND INVASIVE” AMBULATORY INV.
NOSOCOMIAL
PUO
•IN HOSPITALISED PATIENTS TEMP> 101°F DEVELOPS ON SEVERAL OCCASIONS WHO IS
RECEIVING ACUTE CARE AND WHOM WAS NOT MANIFEST OR INCUBATING AT TIME OF
ADMISSION
•3 DAYS OF INV. INCLUDING ATLEAST 2 DAYS INCUBATION OF CULTURES
NEUTROPENIC
PUO
•TEMP> 101°F ON SEVERAL OCCASIONS IN PATIENTS WHOSE NEUTROPHIL
COUNT IS <500uL(n 2-7x10^3) OR EXPECTED TO FALL WITHIN 1-2 DAYS
•NO SPECIFIC CAUSE IDENTIFIED 3 DAYS OF INV. INCLUDING ATLEAST 2 DAYS INCUBATION OF
CULTURES
HIV-
ASSOCIATED
PUO
• >101°F ON SEVERAL OCCASIONS OVER A PERIOD OF >4 WEEKS FOR
OUTPT. OR >3 DAYS FOR INPT. WITH HIV
•NO SOURCE REVELAED OVER 3 DAYS INV. INCLUDING 2 DAYS
INCUBATION OF CULTURES
9. INFECTIONS
Bacterial Infection: Common etiologies
•Chronic sinusitis
•Mastoiditis
•Salmonellosis
•Abscesses(subdiaphragmatic,liver,renal,retroperitoneal,
paraspinal)
•Chronic prostatitis
•Pyelonephritis
•Bacterial endocarditis(esp if caused by HACEK group)
•Osteomyelitis(esp in cases of implantation of
prostheses)
17. A 45 year old man was admitted to the ICU
with acute MI, thrombolysed and
reperfused, but then went into persistent
hypotension following a cardiac arrest. He
developed fever on Day 5. Routine blood
investigation showed a polymorpho-
nuclear leucocytosis. Blood culture was
diagnostic.
What could it be???
18. NOSOCOMIAL PUO
ETIOLOGY
Infections
Non infectious cause
Undiagnosed
Others
•Accounts for 50%
• suspects will be I/V lines, prothesis, septic
phlebitis
•Focused approach on sites where occult
infection may be present eg sinuses of intubated
patients.
Accounts for 25%
•Acalculous cholecystitis
•DVT
•Pulmonary Embolism
Includes drug fever,
withdrawal or
transfusion rxns or post
myocardial infarction
syndrome.
20% remains undiagnosed
19. A 14 year old boy was admitted with high grade
fever and pallor. On examination no
hepatosplenomegaly, lymphadenopathy or bone
tenderness were present. The blood counts were
as follows: Hb 8gm%, TLC 3800, P8 L86 E4 M2,
ESR 20 mm in 1st hr. Platelet count 2.5 lakhs.
What could it be???
20. NEUTROPENIC INFECTIONS
Patients on chemotherapy or immune deficiencies are more
susceptible to:
•Oppurtunistic bacterial infections
•Fungal infections like candidiasis
•Bacteremic infections
•Infections involving catheters
•Perianal infections
Most common etiological agents are:
•Aspergillus
•Candida
•CMV
•Herpes simplex
21. HIV – associated PUO
HIV Infection as such may be the cause
Other secondary causes are:
Pulmonary Tuberculosis
Pneumocystis Infection
Toxoplasmosis
Salmonellosis
Cryptococciosis
Cytomegalovirus infection
M. Avium or M. Intracellulare
Non-Hodgkin’s Lymphoma
Drug induced fever
23. HISTORY TAKING
History of present illness
1)Onset :
• Acute: Malaria, pyogenic infection
• Gradual: TB, typhoid fever
2) Character:
high grade- UTI, TB, malaria, drug
3) Pattern: Whether returns to normal or not
• Sustained/ persistent: typhoid, drugs
27. • Past Medical History
– Malignancy = leukemia, lymphoma, hepatocellular ca
– HIV infection
– DM
– IBD
– collagen vascular disease-SLE, RA, giant cell arteritis
– TB
– Heart disease: valvular heart disease
• Past Surgical History
– Post splenectomy/ post- transplantation
– Prosthetic heart valve
– Catheter, AV fistula
– Recent surgery/ operation
28. • Drug History
– Drug fever occur within 3 months after
start of drugs
• may cause low grade fever, usually
associated with rash
• Due to the allergic reaction, direct effect of
drug which impair temperature regulation
(e.g. phenothiazine)
• E.g. Antiarrhythmic drug: procainamide,
quinidine; Antimicrobial agent: penicillin,
cephalosporin, hydralazine
– After fever: may modify clinical pictures,
mask certain infection e.g. SBE, antibiotic
allergy
46. • Continued observation and
examination
• Therapy based on probability of
various causes of fever in that setting
• Avoid shotgun empirical approach
• Antibiotic??- mask infection
47. Indication for immediate
empirical therapy
• Vital instability
• Neutropenia
• Nosocomial- if bacteremia, fungemia or
persistently high viral loads are a threat
• Cirrhosis, asplenia, immunosuppressive
drug use, exotic travel, environmental
exposures
48. • change IV lines(culture), drugs
stopped for 72 hours and empirical
therapy started
• Vancomycin (MRSA) with
piperacilin/tazobactum(broad
spectrum gram negative)
49. • Granulomatous hepatitis or positive
TST- therapeutic trial for TB upto
6wks
• Glucocorticoids and NSIADS- trial
only after ruling out any infections.
Dramatic response in autoimmune
diseases.
Last resort- if fever continues uptil 6 mnths
50. Initiation of empirical therapy
• Doesnot mark end of treatment
• Rather it commits physician to more
• Thoughtful
• Reeaxamination and
• Evaluation