This document presents a case study of a 7-year-old boy who was bitten by a snake on his left foot. He experienced swelling and pain that progressed up his left leg. He was initially treated with IV fluids, analgesics, and antivenom at a local hospital before being referred for possible antivenom allergy.
On examination, he had swelling up to his knee with tenderness and blebs. Investigations showed elevated white blood cell count. He developed worsening swelling and pus, and was diagnosed with necrotizing fasciitis. He underwent wound debridement and antibiotics were changed. Cultures grew Klebsiella pneumoniae. He was treated surgically and with antibiotics.
Sepsis is leading cause of death in children. septic shock and multi organ dysfunction is final common pathway for death in various infections. We discuss here evidence based management of sepsis and septic shock in children.
Sepsis is leading cause of death in children. septic shock and multi organ dysfunction is final common pathway for death in various infections. We discuss here evidence based management of sepsis and septic shock in children.
This describes leptospirosis pathology, diagnosis, complications and management . This is base on evidence of sri lankan guidelines and research articles
DIC is one condition that always trouble patients and doctor, though its a nightmare for any clinician , its also a potent question in both UG and PG exams. I hope this will help you in answering those questions well.
During the last decades advances in neonatal intensive care have led to an impressive decrease of neonatal mortality and morbidity. However, infectious episodes in the early postnatal period still remain serious and potentially life-threatening events with a mortality rate of up to 50% in very premature infants. [1, 2] The signs and symptoms of neonatal sepsis can be clinically indistinguishable from various noninfectious conditions such as respiratory distress syndrome or maladaptation. Therefore rapid diagnosis is crucial for preventing the child from an adverse outcome. The current practice of starting empirical antibiotic therapy in all neonates showing infection-like symptoms results in their exposure to adverse drug effects, nosocomial complications, and in the emergence of resistant strains. [3] Sepsis results from the complex interaction between the invading microorganism and the host immune, inflammatory, and coagulation response. [4, 5] Inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-15, IL-18, MIF) and growth factors (IL-3, CSFs), and their secondary mediators, including nitric oxide, thromboxanes, leukotrienes, platelet-activating factor, prostaglandins, and complement, cause activation of the coagulation cascade, the complement cascade, and the production of prostaglandins, leukotrienes, proteases and oxidants. [6] Laboratory sepsis markers represent a helpful tool in the evaluation of a child with clinical signs and complement the evaluation of a neonate with a potential infection. During the last decades efforts were done to improve laboratory sepsis diagnosis and a variety of the above mentioned markers and more were studied with different success. Despite the promising results for some of them current evidence suggests that none of them can consistently diagnose 100% of infected cases. C-reactive protein (CRP) is the most extensively acute phase reactant studied so far and despite the ongoing rise (and fall) of new infection markers it still remains the preferred index in many neonatal intensive care units.
It has been prepared according to national guideline on snake bite management in Bangladesh. It would be very much helpful for health care professionals working in Bangladesh
This describes leptospirosis pathology, diagnosis, complications and management . This is base on evidence of sri lankan guidelines and research articles
DIC is one condition that always trouble patients and doctor, though its a nightmare for any clinician , its also a potent question in both UG and PG exams. I hope this will help you in answering those questions well.
During the last decades advances in neonatal intensive care have led to an impressive decrease of neonatal mortality and morbidity. However, infectious episodes in the early postnatal period still remain serious and potentially life-threatening events with a mortality rate of up to 50% in very premature infants. [1, 2] The signs and symptoms of neonatal sepsis can be clinically indistinguishable from various noninfectious conditions such as respiratory distress syndrome or maladaptation. Therefore rapid diagnosis is crucial for preventing the child from an adverse outcome. The current practice of starting empirical antibiotic therapy in all neonates showing infection-like symptoms results in their exposure to adverse drug effects, nosocomial complications, and in the emergence of resistant strains. [3] Sepsis results from the complex interaction between the invading microorganism and the host immune, inflammatory, and coagulation response. [4, 5] Inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-15, IL-18, MIF) and growth factors (IL-3, CSFs), and their secondary mediators, including nitric oxide, thromboxanes, leukotrienes, platelet-activating factor, prostaglandins, and complement, cause activation of the coagulation cascade, the complement cascade, and the production of prostaglandins, leukotrienes, proteases and oxidants. [6] Laboratory sepsis markers represent a helpful tool in the evaluation of a child with clinical signs and complement the evaluation of a neonate with a potential infection. During the last decades efforts were done to improve laboratory sepsis diagnosis and a variety of the above mentioned markers and more were studied with different success. Despite the promising results for some of them current evidence suggests that none of them can consistently diagnose 100% of infected cases. C-reactive protein (CRP) is the most extensively acute phase reactant studied so far and despite the ongoing rise (and fall) of new infection markers it still remains the preferred index in many neonatal intensive care units.
It has been prepared according to national guideline on snake bite management in Bangladesh. It would be very much helpful for health care professionals working in Bangladesh
Snake bite basics in a visually appealing format for general population, school and college students, medical students, paramedics, nurses, and pg residents. Snakes included only pertaining to indian subcontinent. Any medical data given is valid only for indian subcontinent.
Snake bite and its management by first aid and antivenomShwetaKhadka
about snake bite ,venom,types of venom,first aid,antivenom,and management ,epidemiology ,dosage and route of antivenom administration , anaphylactic reaction due to antivenom , general symptoms of snake bite,immobilization process , formation of antivenom
This pptx is on recognition of different snakes, snake bite management particularly in children. At the end of the slide show you will definitely able to recognize and manage snake bites.
Hopes everybody will be able to understand the signs and symptoms of snake bite and can know which are the most common poisonous snakes in India. This is for everybody not only medicos.
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.
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- 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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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2. • 7 yr old boy brought with alleged h/o unknown
bite on 11/03/17 at 10:30 am at home.
• Site of bite- dorsum of left foot
• C/o Excrutiating pain and swelling on the left leg.
• After 1 hr child sustained localised swelling,H/o
progression of swelling upwards till left knee
associated with pain.
• No h/o bleeding from the site, LOC, Seizures, Ptosis
• No respiratory distress
3. • Past History:
No significant past history
• Family History: Nil significant
• Antenatal and perinatal history: Nil significant
• Immunisation History: Upto date
• Growth and development: Normal
4. Treatment History:
• Child was immediately taken to Kallukurichi
GH, diagnosed as snake bite with cellulitis of
left leg.
• Treated with IV fluids, Inj.Tramadol, Inj.Rantac,
Inj.Taxim, Inj.Metrogyl, ASV.
• Dose of ASV not mentioned. Not given
premedications
• Referred that day for ASV allergy.
5. ON EXAMINATION
Initial assessment: Stable
Primary assessment : Normal - (Urgent)
Active,febrile
GCS-15/15
Vitals:
Temperature-100 F
PR-130/min
RR-24/min
CFT-<3 sec
BP-130/90mmHg
Breath holding time – adequate
No bleeding sites
7. LOCAL EXAMINATION:
• Warmth,swelling and tenderness till distal one
third of the lower limb(Below knee)
• Fang mark on the dorsum of the left foot
• Blebs and discolouration present
• Peripheral pulses felt, no evidence of
compartment syndrome
• Left inguinal lymphadenopathy present- Tender+
8.
9. • Provisional diagnosis of Left leg cellulitis-
secondary to ?snake bite envenomation was
made and child was shifted to PICU
• Whole blood clotting time done- less than 20mins
• CBC showed TLC 12,000 with plt of 2.18lakhs
• RFT was normal
• Child empirically started on iv ceftriaxone and
metronidazole
• Monitored for urine output, increase in
swelling,compartment syndrome.
10. • On day 3 of hospitalization - pus c/s was sent
from the bleb.
• Pediatric surgery opinion taken on day 3 of
hospitalization- Opined as Necrotizing fascitis
of leg.(Evolving)
• Iv antibiotics was changed to ampiclox and
amikacin and metronidazole was continued.
• Wound debridement with fasciotomy was
done on day 5 of hospitalisation. Tissue
culture was sent.
11. • Pus c/s (aerobic & tissue culture showed
evidence of klebsiella pneumoniae sensitive to
the ciprofloxacin, ceftriaxone, amikacin,
magnex, meropenem
• Anaerobic culture : sterile
12. • Taken over by paediatric surgery. Daily wound
dressing done.
• Planned to do skin grafting after 2 weeks.
13. Snake Envenomation
• Highest Mortality in the world.
• Deaths of 30,000 per annum. (WHO 2009)
• 236 species of snakes in India
• 15 varieties are poisonous.
• Cobra, Russell's viper, saw- scaled,vipers and
krait are the most common.
18. Common Name
of
the snake
Nature of
Toxin
Local symptoms and
signs at bite
Systemic Signs and
Symptoms
Russell's Viper Haemotoxic
Neurotoxic
1.Pain at bite site
2.Ecchymoses and
3.swelling
4.Blister formation
5.Necrosis of the limb
1.Rise in CT/BT
2. Bleeding from
various sites.
3. AKI
Saw Scaled Viper Haemotoxic 1.Local pain
2.Ecchymoses
3.swelling
4.Bleeding from the
site
5.Rapid discolouration
1.Rise in CT/BT.
2.Bleeding from
various sites.
19. Common Name of
the snake
Nature of
Toxin
Local symptoms
and signs at bite
Systemic Signs and
Symptoms
Cobra Neurotoxic
(post synaptic)
1.Local pain.
2.Swelling.
3.Ecchymoses
4.Local necrosis
1.Sluggish pupillary
Response.
2.Diplopia, Ptosis,
Dilated pupils,
arrhythmia.
3.Difficulty in breathing,
Hypotension.
4.Unconscious state.
20. Common Name of
the snake
Nature of
Toxin
Local symptoms
and signs at bite
Systemic Signs and
Symptoms
Common Krait Neurotoxic
(pre-synaptic)
1.Small puncture
marks.
2.Minimal or
absent
Iocal symptoms
3.GI
Manifestations.
1.Sluggish pupillary
response, ptosis,
Diplopia, Dilated Pupils.
2.Difficulty in
swallowing due to
Glossopharyngeal
dysfunction.
3. Difficulty in
Respiration.
4. Arrhythmia,
hypotension, Ioss of
conciousness, coma,
respiratory arrest, and
sudden cardiac arrest.
21. “Do it R.I.G.H.T”
• R: Reassure the patient.
• I: Immobilise in the same way as a fractured
limb.
• G.H: Get to Hospital Immediately.
• T: Tell the doctor of any systemic symptoms
such as ptosis that manifest on the way to
hospital.
22. Methods to be Discarded
• Tourniquets
• Cutting and Suction
• Washing the Wound
• Pressure Immobilisation Method (PIM)
• Freeze or apply extreme cold to the area of
the bite.
• Attempt to suck venom out with mouth
23. Approach
• Initial Assessment and history.
• Symptoms:
Feature Cobras Kraits Russell's
Viper
Saw ScaIed
Viper
Local Pain/ Tissue Damage yes No Yes Yes
Ptosis/ Neurological Signs Yes Yes Yes No
Haemostatic
abnormalities
No No Yes Yes
Renal Complications No No Yes No
Response to Neostigmine Yes No No No
Response to ASV Yes Yes Yes Yes
24. • Hump nose viper
• Common in kerala
• Hemotoxic and nephrotoxic
• AVAILABLE ASV IS NOT EFFECTIVE
25. Investigations
• 20 minutes whole blood clotting test
• Haemoglobin/ Pcv/ Platelet count/ PT/ APTT/
FDP/ D-Dimer
• A Peripheral Smear
• Urine for for Proteinuria/ RBC/
haemoglobinuria/ myoglobinuria
• Sr.creatinine/urea/Potassium
26. TREATMENT
• Managing pain:
This can be treated with painkillers such as
Paracetamol.
• Handling Tourniquets:
Before removal of the touniquet, check for the
presence of pulse distal to the tourniquet.
27. Anti Snake Venom (ASV)
• INDICATION:
Evidence of systemic envenomation
Evidence of coagulopathy: Primarily detected by
2OWBCT or visible spontaneous systemic
bleeding etc.
Evidence of neurotoxicity: Ptosis, external
ophthalmoplegia, muscle paralysis,inability to
lift the head etc
Severe Local envenomation
28. • Premedication :
Hydrocortisone 2-5 mg/Kg
Chlorpheniramine 0.1-0.3 mg/kg
Ranitidine 2 mg /kg
Dosage: 10 vials
Russell's viper injects 63mg (Range 5mg - 147
mg; SD 7 mg) of venom- each vial contains
6mg of ASV
29. • Route of administration- Intravenous infusion
10 vials of ASV is diluted in 10-20ml/kg of
isotonic saline and given over one hour
• Child is monitored closely for ASV related
reactions.
Locally instilling ASV on bite site to be avoided
30. ASV Reactions
In cases of anaphyllaxis
• Discontinue ASV infusion
• 0.01mg/kg adrenaline 1 :1000 given IM
• Second or third dose may be repeated if
symptoms not reversed
• If anaphyllactic shock – start adrenaline
infusion
• Once recovered, ASV can be restarted slowly
31. Recovery Signs
• Spontaneous systemic bleeding such as gum
bleeding usually stops within 15 – 30 minutes.
• Blood coagulability is usually restored in 6 hours.
Principal test is 2OWBCT.
• Post synaptic neurotoxic envenoming such as in
Cobra bites, may begin to improve as early as 30
minutes after antivenom, but can take several
hours.
• Active haemolysis and rhabdomyolysis may
cease within a few hours and the urine returns to
its normal colour.
• In patients with Shock, blood pressure may
increase after 30 minutes
32. When and how much repeat dose
• Hemotoxic snake bite:
Maximum 25 vials
After 6 hours
• Neurotoxic snake bite:
Maximum 20 vials
After 1-2 hours
33. • Why ASV not effective after delayed
presentation or persistent local swelling?
ASV acts in the circulation to prevent binding
of unbound venom
35. Surgical Complications
• Ulcer following snakebite
• Necrosis of the skin and underlying tissues
• Gangrene of the toes and fingers
• Debridement of necrotic tissues
• Compartment syndrome.
36. Role of Antibiotics
• Most common organism causing local reactions or infection
- Staph. Aureus
- E. Coli
- Different choices being mentioned
Combination of ampiclox and cefotaxime
Ciprofloxacin
Metronidazole to cover anaerobes
Reference:
1.Dhanya Sasidharan Palappallil et al., Antibiotic Usage After Snake Bite
Journal of Clinical and Diagnostic Research. 2015 Aug, Vol-9(8)
Kerala Based Study.
2. Wound infections secondary to snakebite
Atul Garg, S. Sujatha, Jaya Garg, N. Srinivas Acharya, Subhash Chandra Parija
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical
Education and Research (JIPMER), Pondicherry
37.
38.
39.
40.
41.
42. How do we decide on Antibiotics??
• Invariably skin gets necrosed after initial few
days of snake bite due to proteolytic
properties of venom.
• If no features of septicemia or if local skin
appears relatively healthy amoxyclav or
ceftriaxone or ciprofloxacin is enough.
• If skin shows necrotising features or child is
very toxic then Cloxacillin (or piptaz )+
amikacin + metronidazole can be added.