Common Respiratory Manifstation of HIV. As CD 4 count has been diminished there are multiple other oppertynistic infection has occured.
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Content & references in part including multimedia content (illustrations, videos) might be taken from the public domain, by no means, aiming at copyrights infringement. All intellectual property rights reserved with the owners.
Content & references in part including multimedia content (illustrations, videos) might be taken from the public domain, by no means, aiming at copyrights infringement. All intellectual property rights reserved with the owners.
To prevent the spread of COVID-19:
Clean your hands often. Use soap and water, or an alcohol-based hand rub.
Maintain a safe distance from anyone who is coughing or sneezing.
Wear a mask when physical distancing is not possible.
Don’t touch your eyes, nose or mouth.
Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
Stay home if you feel unwell.
If you have a fever, cough and difficulty breathing, seek medical attention.
Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you, and prevents the spread of viruses and other infections.
Masks
Masks can help prevent the spread of the virus from the person wearing the mask to others. Masks alone do not protect against COVID-19, and should be combined with physical distancing and hand hygiene. Follow the advice provided by your local health authority.
More than 5.7 million new cases of TB (all forms, both pulmonary and extra-pulmonary) were reported to the World Health Organization (WHO) in 2013; 95% of cases were reported from developing countries
Latest figures from 20151 indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400 000 HIV positive).
Of further concern is that 480 000 cases of multidrug-resistant (MDR) TBa and a further 100 000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period.
THIS SLIDE CONTAION DATA OF EUROLOGICAL MANIFESTATION OF HIV IN NEPAL.
KLASLAHSJA LASKHKSJH KJSCGJASJ KJASHCKJASGC AJKSGCKJASC LASHCyip qpwoiupqw pqwudpqwylhsch puaiochkhcpAIC LKAJXIYA KJXO a aiyc oacy ioAHXlk cpcopAUC APOU paocu AHCGIUW CAC AC apcyioiac A C AC ACA c AC A AKch c pAIYC aipcu ipAYC I apuA C
To prevent the spread of COVID-19:
Clean your hands often. Use soap and water, or an alcohol-based hand rub.
Maintain a safe distance from anyone who is coughing or sneezing.
Wear a mask when physical distancing is not possible.
Don’t touch your eyes, nose or mouth.
Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
Stay home if you feel unwell.
If you have a fever, cough and difficulty breathing, seek medical attention.
Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you, and prevents the spread of viruses and other infections.
Masks
Masks can help prevent the spread of the virus from the person wearing the mask to others. Masks alone do not protect against COVID-19, and should be combined with physical distancing and hand hygiene. Follow the advice provided by your local health authority.
More than 5.7 million new cases of TB (all forms, both pulmonary and extra-pulmonary) were reported to the World Health Organization (WHO) in 2013; 95% of cases were reported from developing countries
Latest figures from 20151 indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400 000 HIV positive).
Of further concern is that 480 000 cases of multidrug-resistant (MDR) TBa and a further 100 000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period.
THIS SLIDE CONTAION DATA OF EUROLOGICAL MANIFESTATION OF HIV IN NEPAL.
KLASLAHSJA LASKHKSJH KJSCGJASJ KJASHCKJASGC AJKSGCKJASC LASHCyip qpwoiupqw pqwudpqwylhsch puaiochkhcpAIC LKAJXIYA KJXO a aiyc oacy ioAHXlk cpcopAUC APOU paocu AHCGIUW CAC AC apcyioiac A C AC ACA c AC A AKch c pAIYC aipcu ipAYC I apuA C
Similar to Respiratory Manifestations of HIV.ppt (20)
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. National Centre for AIDS
and STD Control
Session Objectives
By the end of the session participants will be able to:
• List out the various etiological agents that cause
respiratory infections
• Describe the clinical presentation of specific
respiratory infections
3. National Centre for AIDS
and STD Control
Overview
• Respiratory manifestations are major cause of
morbidity and mortality
• Two third of PLHIV might have preventable and
treatable RTI
4. National Centre for AIDS
and STD Control
Differential diagnosis of respiratory infections in HIV
Mycobacterial Infection Mycobacterium Tuberculosis
Mycobacterium Avium Complex
Bacterial Infection Streptococcus pneumoniae,
Haemophilus influenzae,
Staphylococcus aureus,
Moraxella cattharalis,
Klebsiella pneumoniae,
Pseudomonas aeruginosa
Fungal infection
Pneumocystis jiroveci,
Penicillium marneffei,
Cryptococcus neoformans,
Histoplasmosis,
Coccidioidomycosis,
Aspergillosis
Helminthic infection: Strongyloides stercoralis,
Paragonimus westermanii
Protozoal infection Toxoplasmosis gondii
5. National Centre for AIDS
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Association of pulmonary infections with CD4 count
Infection CD4 count
Mycobacterium tuberculosis Can occur at any CD4
Bacterial pneumonia Can occur at any CD4
Pneumocystis jiroveci pneumonia <200
Mycobacterium avium complex <100
Cytomegalovirus <100
6. National Centre for AIDS
and STD Control
Case Studies
Case Study #1:
Saroj, a 38 year old man from Ranibari, a rural village,
who tested positive for HIV after attending an STI clinic
2 years ago, comes to see you. He has never had a CD4
done. He has taken no medications recently. Besides STI
related symptoms, he has been quite healthy, but now
complains of 2 days of severe cough, spiking fevers,
greenish sputum production and pleuritic chest pain.
He is admitted to the district hospital.
On Examination: body temperature :39°C, abnormal
breath sounds
His CXR is as shown:
7. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #1 (continued)
8. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #1 (continued)
• What is in your differential diagnosis?
• What is the most likely diagnosis?
• What further investigations would you perform?
• What are this patient’s needs?
• What treatment would you offer?
9. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #1 (continued)
• Patient’s sputum smear is
shown
• What organism do you
suspect to be the cause of
his illness?
10. National Centre for AIDS
and STD Control
• Common etiological agents: Streptococcus
pneumoniae, Hemophilus Influenzae, Staph aureus
• Clinical presentation: Abrupt onset with fever,
cough, production of purulent sputum, dyspnea, and
pleuritic chest pain
Bacterial Pneumonia
11. National Centre for AIDS
and STD Control
• Recommended diagnostics: Chest X-ray, blood
culture, FBC, gram stain of sputum, sputum culture
and sensitivity
• Common findings: X-ray may show pneumonic
consolidation, infiltrates, or pleural effusion;
leukocytosis; blood cultures may be positive
Bacterial Pneumonia (continued)
12. National Centre for AIDS
and STD Control
Management and Treatment
Mild Pneumonia:
– Preferred- Amoxicillin PO or IV
– Alternative- Erythromycin or Doxycycline
Moderate to Severe pneumonia:
– Amoxicillin/Clavulanic Acid Or 2nd or 3rd generation
cephalosporin (Cefaclor, Cefuroxime or Ceftriaxone) Plus
– Coverage for atypical (Azithromycin or Doxycycline)
Staph Pneumonia (if proven)
Cloxacillin, Flucloxacillin, Amoxi-Clav and Clindamycin
Bacterial Pneumonia (continued)
13. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #2
Shyam Prasad, a 40-year-old man, is complaining of
fever, dry cough and shortness of breath (SOB) for ten
days. His doctor gave him amoxicillin and erythromycin
because of his cough, with no improvement. He is
hospitalized now with severe SOB.
14. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #2 (continued)
Past Medical History:
He has been HIV + for eight years. He was successfully
treated for pulmonary tuberculosis four years ago. One
year ago he had a medical checkup in Europe. His CD4
count was 80. Cotrimoxazole and triple combination ART
was prescribed. He started this treatment but stopped
taking drugs three months later because of alcohol
consumptions.
15. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #2 (Continued)
Physical Examination:
His temperature is 37.8 °C. Lung auscultation is normal.
His chest x-ray is as follows.
16. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #2 (continued)
17. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #2:
What is in your differential diagnosis?
What is the most likely diagnosis?
What further investigations would you perform?
What are Shyam Prasad’s needs?
What treatment would you offer?
18. National Centre for AIDS
and STD Control
Pneumocystis jirovecii pneumonia
(PCP)
19. National Centre for AIDS
and STD Control
PCP
Etiological agent: Pneumocystis jiroveci (classified as fungal)
Clinical presentation: Dry cough, progressive shortness of
breath, fever, few chest signs, often nonspecific and insidious
Recommended diagnostics: CXR. Generally a clinical diagnosis
in Nepal and often requires invasive procedure such as Broncho-
alveolar lavage (BAL). If CXR not informative, CT-Thorax chest can
be done
Common findings: Chest x-ray shows bilateral lace-like
interstitial infiltrates extending from the perihilar region or may
be normal
CT Thorax- round glass lesion
21. National Centre for AIDS
and STD Control
Management and treatment:
– TMP-SMX high dose PO or IV x 21 days
Cotrimoxazole15mg/kg divide into 3 or 4 times per
day:
• 2 SS tab QID if <40kg
• 3 SS tab QID if >40kg
– If hypoxic, add Prednisolone 40 mg bid for 5 days,
then taper
PCP (continued)
22. National Centre for AIDS
and STD Control
Thorax CT indications
STEP 1: Presence of respiratory symptoms
Dypnoea, TB symptoms ?
23. National Centre for AIDS
and STD Control
Thorax CT indications
STEP 2: Chest-X-ray AND CD4 <350/mm3
STEP 1: Presence of respiratory symptoms
Dypnoea, TB symptoms ?
24. National Centre for AIDS
and STD Control
Thorax CT indications
STEP 2: Chest-X-ray AND CD4 <350/mm3
Typical lesion
STEP 1: Presence of respiratory symptoms
Dypnoea, TB symptoms ?
25. National Centre for AIDS
and STD Control
Thorax CT indications
STEP 2: Chest-X-ray AND CD4 <350/mm3
Typical lesion
STEP 1: Presence of respiratory symptoms
STOP
Dypnoea, TB symptoms ?
26. National Centre for AIDS
and STD Control
Thorax CT indications
STEP 2: Chest-X-ray AND CD4 <350/mm3
No lesion
OR
Any atypical lesion
Typical lesion
STEP 1: Presence of respiratory symptoms
STOP
Dypnoea, TB symptoms ?
27. National Centre for AIDS
and STD Control
Thorax CT indications
STEP 2: Chest-X-ray AND CD4 <350/mm3
No lesion
OR
Any atypical lesion
Typical lesion
STEP 1: Presence of respiratory symptoms
STOP
Thorax CT
Dypnoea, TB symptoms ?
28. National Centre for AIDS
and STD Control
Case Studies
Case Study #3
Tara is a 26 year old HIV positive FSW who presents
with chronic cough for 4 weeks. She reports frequent
fevers and denies sputum production. She has lost
weight (about 3 kg) over the past month. She
reportedly had a “suspicious” CXR so a trial of
antibiotics (Amoxicillin and Erythromycin) were given
for 2 weeks. Symptoms are unchanged.
29. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #3 (continued)
• What is in your differential diagnosis
• What is the most likely diagnosis?
• What further investigations would you perform?
• What are this patient’s needs?
• What treatment would you offer?
30. National Centre for AIDS
and STD Control
Case Studies (continued)
Case Study #3 ( continued)
You obtained a CXR
yourself and this is what
you saw.
How would you describe
this CXR?
31. National Centre for AIDS
and STD Control
Tuberculosis
Further discussion of the interaction of TB and HIV
will take place during the co-infections session