RSV bronchiolitis is a common lower respiratory tract infection in infants under 2 years old, characterized by wheezing. It is most often caused by the RSV virus. RSV spreads easily among children and causes seasonal epidemics in the winter. Symptoms range from mild to severe and include rhinorrhea, cough, wheezing and respiratory distress. Treatment focuses on supportive care and oxygen supplementation for severe or hypoxic cases. While most cases resolve without long term effects, some children may develop recurrent wheezing or asthma.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
Pneumonia is an infection of the lungs. The air sacs in the lungs (called alveoli) fill up with pus and other fluid, which makes it hard for oxygen to reach the bloodstream.
Someone with pneumonia may have a fever, cough, or trouble breathing.
Fever, common cold and cough in pediatric age groups are common. Acute bronchiolitis is a diagnostic term used to describe the clinical picture produced by several different lower respiratory tract infections in infants and very young children (younger than 1yr ,some clinicians extend it to the age of 2 yr). Pneumonia defined as inflammation of lung parenchyma.
It is the leading infectious cause of death globally among children younger than 5 yr.
The introduction of antibiotics and vaccine against measles , pertussis ,haemophilus influenzae type b and PCV vaccine reduces the pneumonia related mortality over past 15 yr.
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.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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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.
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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.
Stay informed, stay safe, and get your flu shot today!
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
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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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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2. DEFINITION
Bronchiolitis is broadly defined as a clinical syndrome that occurs in children <2
years of age and is characterized by upper respiratory symptoms (eg, rhinorrhea)
followed by lower respiratory (eg, small airway/bronchiole) infection with
inflammation, which results in wheezing and or crackles (rales). Bronchiolitis
typically occurs with primary infection or reinfection with a viral pathogen, but
occasionally is caused by bacteria (eg, Mycoplasma pneumoniae). In young
children, the clinical syndrome of bronchiolitis may overlap with recurrent virus-
induced wheezing and acute viral-triggered asthma.
3. ETIOLOGY
RSV is an enveloped RNA virus with a single-stranded negative sense genome that
replicates entirely in the cytoplasm of infected cells and matures by budding from
the apical surface of the cell membrane.
The virus belongs to the family Paramyxoviridae, subfamily Pneumoviridae.
There are 2 antigenic subgroups of RSV, based primarily on variation in 1 of the 2
surface proteins, the G glycoprotein that is responsible for attachment.
This antigenic variation caused by point mutations from infidelity of the virus RNA
polymerase may to some degree contribute to the frequency with which RSV
reinfects children and adults.
4. EPIDEMIOLOGY
RSV is distributed worldwide and appears in yearly epidemics. In temperate
climates, these epidemics occur each winter over 3 – 4 months.
RSV outbreaks often overlaps with outbreaks of influenza and human
metapneumovirus but are more consistent from year to year and result in more
disease overall, especially in infants younger than 6 months of age.
Transplacentally acquired anti RSV maternal IgG serum antibodies, if present in
high concentration, appear to provide partial but incomplete protection.
Breastfeeding also provides substantial protection.
5. Reinfection occurs at a rate of at least 10-20% per epidemic throughout childhood.
The severity of illness in reinfection is usually lower and appears to be a function of partially acquired
immunity, more robust airway physiology and increased age.
Asymptomatic RSV infection is unusual in young children.
All RSV diseases of the lower respiratory tract have their highest incidence at 6 weeks – 7 months of age
and decrease thereafter.
RSV plays a causative role in 40 – 75% cases of hospitalized bronchiolitis.
RSV bronchiolitis is more common in boys than girls in the ratio of 1.5:1.
Other risk factors include white race, 1 or more siblings in the home, rural residence, maternal smoking.
6. The incubation period from exposure to first symptoms is approx. 3 – 5 days.
Most infants with lower respiratory tract illness shed infectious virus for 1-2 weeks
after hospital admission. Excretion for 3 weeks and even longer has been
documented.
Spread of infection occurs when large, infected droplets, either airborne or
conveyed on hands or other fomites, are inoculated in the nasopharynx of a
susceptible subject.
Nosocomial infection during RSV epidemics is an important concern.
Contact precautions are sufficient to prevent spread when compliance is
meticulous, as the virus is not usually spread by small particle aerosol.
7. PATHOGENESIS
Bronchiolitis is caused by obstruction and collapse of the small airways during
expiration
Infants are particularly apt to experience small airway obstruction due to the small
size of their normal bronchioles, airway resistance is proportional to 1/r4
Airway narrowing likely is caused by virus induced necrosis of the bronchiolar
epithelium, hyper secretion of mucus, and round cell infiltration and edema of the
surrounding submucosa. These changes result in formation of mucus plugs
obstructing bronchioles, with consequent hyperinflation or collapse of the distal
lung tissue.
The immune response required to eliminate virus infected cell causes host cell
death while reducing the cells producing virus.
8. CLINICAL MANIFESTATIONS
Typically, the first sign of infection in infants with RSV is rhinorrhea. Cough may
appear simultaneously but more often does so after an interval of 1-3 days at
which time there may also be sneezing and a low grade fever.
Soon after the cough develops the child begins to wheeze audibly.
If the disease is mild, the symptoms may not progress beyond this stage.
Auscultation often reveals diffuse fine inspiratory crackles and expiratory wheezes.
Chest radiograph findings at this stage is frequently normal.
9. If the illness progresses, cough and wheezing worsen and air hunger ensues, with
increased respiratory rate, intercostal and subcostal retractions, hyper expansion of
the chest , restlessness and peripheral cyanosis.
Signs of severe life threatening illness are central cyanosis, tachypnea of > 70
breaths/min, listlessness and apneic spells. At this stage, the chest maybe
significantly hyperexpanded and almost silent to auscultation due to poor air
movement.
CXR findings maybe normal in 30% of cases while the other 70% may show hyper
expansion of the chest, peribronchial thickening, and interstitial infiltrates.
In young infants, particularly premature infants, periodic breathing and apneic
spells have been distressingly frequent signs even with relatively mild disease.
10. DIAGNOSIS
Bronchiolitis is a clinical diagnosis.
RSV can be suspected on the basis of the season of the year and the presence of virus in the
community.
Other features which maybe helpful are the presence of cold in older household contacts and the
age of the child.
The WBC count is normal or elevated, and the differential cell count maybe normal with either a
neutrophilic or mononuclear predominance.
Hypoxemia as measured by pulse oximetry or ABG analysis is frequent.
11. CXR may show hyperinflation with peribronchial thickening.
Definitive diagnosis of RSV is based on the detection in respiratory secretions of
live virus by cell culture. The presence of viral RNA (detected by PCR) or viral
antigens (detected by a rapid diagnostic test) is strongly supportive in the right
clinical setting.
An aspirate of mucus or nasopharyngeal wash from the child’s posterior nasal
cavity is the optimal specimen. Nasopharyngeal or throat swabs are less preferable
but acceptable.
The specimen should be placed on ice taken directly to the lab and processed
immediately for culture, antigen or PCR analysis as the virus is thermo labile.
12. TREATMENT
The treatment of uncomplicated cases of bronchiolitis is symptomatic.
Humidified oxygen and suctioning are usually indicated for hospitalized patients
who are hypoxic.
Many infants are slightly to moderately dehydrated, and therefore fluids should be
carefully administered in amounts somewhat greater than those for maintenance.
Often IV or tube feeding is helpful when sucking is difficult because of tachypnea.
Aerosolized saline or hypertonic saline , epinephrine or beta2 agonists is used as an
adjunct therapy.
Combined therapy with inhaled epinephrine and dexamethasone has been used
with some success.
Antibiotics are not useful in nearly all instances of bronchiolitis.
13. SEVERITY ASSESSMENT
In general, we consider severe bronchiolitis to be indicated by any of the following:
●Persistently increased respiratory effort (tachypnea; nasal flaring; intercostal, subcostal, or
suprasternal retractions; accessory muscle use; grunting) as assessed during repeated
examinations separated by at least 15 minutes
●Hypoxemia (SpO2 <95 percent); SpO2 should be interpreted in the context of other clinical
signs, the state of the patient (eg, awake, asleep, coughing, etc), and altitude
●Apnea
●Acute respiratory failure
We consider nonsevere bronchiolitis to be indicated by the absence of all of the above.
However, the severity categories may overlap and clinical judgment is necessary to
make appropriate management decisions.
Repeated observations are necessary to adequately assess disease severity because
examination findings may vary substantially over time
14. NONSEVERE BRONCHIOLITIS
Supportive care and anticipatory guidance are the mainstays of management of
non severe bronchiolitis.
Supportive care includes maintenance of adequate hydration, relief of nasal
congestion/obstruction, and monitoring for disease progression.
For infants and children with non severe bronchiolitis who are treated in the office
or emergency department, we suggest not routinely treating with nebulized
hypertonic saline.
15. SEVERE BRONCHIOLITIS
Supportive care includes maintenance of adequate hydration, respiratory support,
and monitoring for disease progression.
Fluid management
Respiratory support – saturation > 92 %
Nasal suctioning
Supplemental oxygen
Although we do not routinely suggest inhaled bronchodilators for the
management of bronchiolitis, a one-time trial of inhaled bronchodilators (albuterol
[salbutamol] or epinephrine) and glucocorticoids may be warranted for infants and
children with bronchiolitis and severe disease.
16. PROGNOSIS
The mortality rate of hospitalized infants with RSV is very low in the developed
world.
Almost all deaths occur among young, premature infants or infants with underlying
disease of the neuromuscular, pulmonary, cardiovascular or immunologic system.
Many children with asthma have a history of bronchiolitis in infancy.
There is recurrent wheezing in 30-50% of children with severe RSV bronchiolitis in
infancy.
17. PREVENTION
In the hospital, the most important preventive measures are aimed at preventing
nosocomial spread.
Gowns, gloves and careful hand washing should be used for the care of all infants
with suspected or established RSV infection.
Ideally patients with RSV are housed separately, because coinfection maybe
associated with more severe disease.
Palivizumab (15 mg/kg once a month) is recommended for protecting high risk
children against serious complications from RSV disease.
There is no licensed vaccine against RSV.