Elizabethkingia meningoseptica is emerging as a cause of hospital acquired infection particularly in immunocompromised adults. The treatment of this bacterium is difficult since it is intrinsically resistant to a number of antibiotics. Here we report two cases of septicemia in patients who were critically ill and were successfully treated with appropriate antibiotics. Cotrimoxazole, quinolones, and rifampicin seem to be drugs effective against E. meningoseptica. Antibiotic susceptibility results are ineffective in guiding treatment. The bacterium particularly colonizes water pipelines and tap faucets and occurrence of infection by this bacterium should direct attention towards eradicating the source of this bacterium.
Infective endocarditis is an infection of the heart valves or endocardium. It occurs at a rate of 10,000-20,000 cases per year in the US. Staphylococcus aureus is the most common cause. Diagnosis is made using the Modified Duke Criteria which considers blood culture results, echocardiogram findings, and clinical features. Treatment involves prolonged antibiotic therapy for 4-6 weeks depending on the causative organism. Surgery may be required for complications or refractory infection. Prophylaxis with antibiotics is recommended for certain high risk dental and surgical procedures to prevent bacteremia and seeding of valves.
This document provides an overview of systemic lupus erythematosus (SLE) in children and adolescents. Key points include: SLE is an autoimmune disease affecting multiple organs, most commonly the skin, joints, kidneys, blood cells, blood vessels and central nervous system. Diagnosis requires meeting 4 out of 11 classification criteria. Management involves controlling disease activity and flares with corticosteroids and immunosuppressive drugs like hydroxychloroquine and azathioprine. Prognosis has improved over time but organ involvement like lupus nephritis can be severe and require aggressive treatment.
This document discusses fluid management in dengue hemorrhagic fever and dengue shock syndrome. It describes the pathogenesis of plasma leakage during the critical phase of DHF and guidelines for fluid resuscitation using crystalloids and colloids. Key recommendations include meticulous monitoring of patients, matching fluid infusion rates to the rate of plasma leakage, and recognizing when to switch between crystalloid and colloid fluids or give blood transfusions to treat shock.
The document discusses gastrointestinal hormones GLP-1 and GIP that enhance food-induced insulin secretion. GLP-1 is the most important incretin hormone, secreted by L cells in the ileum and colon from proglucagon. It stimulates insulin release, improves hepatic insulin resistance, increases beta cell mass, and stimulates beta cell production. GIP is called glucose-dependent insulinotropic polypeptide and is released from K cells in the duodenum and proximal jejunum in response to food.
This document discusses ductus arteriosus dependent congenital heart diseases. It begins by defining ductus dependent circulation as abnormalities where ductus arteriosus patency is required to maintain systemic perfusion. It then describes the anatomy and physiology of the ductus arteriosus, noting its role in diverting blood from the pulmonary to systemic circulation in fetal life. The document outlines conditions of ductus dependent pulmonary and systemic blood flow. It discusses goals of management as minimizing hypoxemia and balancing pulmonary and systemic circulations. Maintaining ductal patency with prostaglandins is emphasized as critical for stabilization in ductus dependent lesions.
This document provides question and answer summaries from an OSCE exam in pediatrics. It includes 20 stations covering topics like lung lobe and segment identification, developmental screening tools, interpreting blood gases and X-rays, diagnoses for various clinical presentations, and questions on management of conditions like anaphylaxis, scurvy, pulmonary vasculitis, cystic fibrosis and more. Treatment, investigations, genetic causes are discussed. The last few stations address questions on secondary prophylaxis for rheumatic fever.
Pernicious malaria is a severe form of Plasmodium falciparum malaria that can threaten a patient's life within 1 to 3 days if not treated effectively. It results from capillary blockage caused by the agglutination of parasitized erythrocytes in the blood vessels of internal organs. This leads to decreased blood flow and volume. Manifestations include cerebral malaria with coma and paralysis, algid malaria with cold skin and circulatory failure, and septicemic malaria with high fever, pneumonia and cardiac issues. Pathology findings include brain, gastrointestinal tract, and lung tissue damage from congested capillaries filled with parasitized red blood cells.
Here are three more potential causes of paralysis in patients with AIDS:
- Cryptococcal meningitis: The most common fungal infection of the CNS in AIDS patients. Can cause increased intracranial pressure, cranial neuropathies, and spinal cord compression.
- Progressive multifocal leukoencephalopathy (PML): Caused by JC virus reactivation in AIDS patients. Presents with cognitive impairment, visual changes, and sometimes motor deficits. MRI often shows multifocal white matter lesions.
- Vacuolar myelopathy: Caused by HIV itself. Presents with spastic paraparesis. MRI may show T2 hyperintensities in the lateral and posterior columns of the spinal cord. Treat
Infective endocarditis is an infection of the heart valves or endocardium. It occurs at a rate of 10,000-20,000 cases per year in the US. Staphylococcus aureus is the most common cause. Diagnosis is made using the Modified Duke Criteria which considers blood culture results, echocardiogram findings, and clinical features. Treatment involves prolonged antibiotic therapy for 4-6 weeks depending on the causative organism. Surgery may be required for complications or refractory infection. Prophylaxis with antibiotics is recommended for certain high risk dental and surgical procedures to prevent bacteremia and seeding of valves.
This document provides an overview of systemic lupus erythematosus (SLE) in children and adolescents. Key points include: SLE is an autoimmune disease affecting multiple organs, most commonly the skin, joints, kidneys, blood cells, blood vessels and central nervous system. Diagnosis requires meeting 4 out of 11 classification criteria. Management involves controlling disease activity and flares with corticosteroids and immunosuppressive drugs like hydroxychloroquine and azathioprine. Prognosis has improved over time but organ involvement like lupus nephritis can be severe and require aggressive treatment.
This document discusses fluid management in dengue hemorrhagic fever and dengue shock syndrome. It describes the pathogenesis of plasma leakage during the critical phase of DHF and guidelines for fluid resuscitation using crystalloids and colloids. Key recommendations include meticulous monitoring of patients, matching fluid infusion rates to the rate of plasma leakage, and recognizing when to switch between crystalloid and colloid fluids or give blood transfusions to treat shock.
The document discusses gastrointestinal hormones GLP-1 and GIP that enhance food-induced insulin secretion. GLP-1 is the most important incretin hormone, secreted by L cells in the ileum and colon from proglucagon. It stimulates insulin release, improves hepatic insulin resistance, increases beta cell mass, and stimulates beta cell production. GIP is called glucose-dependent insulinotropic polypeptide and is released from K cells in the duodenum and proximal jejunum in response to food.
This document discusses ductus arteriosus dependent congenital heart diseases. It begins by defining ductus dependent circulation as abnormalities where ductus arteriosus patency is required to maintain systemic perfusion. It then describes the anatomy and physiology of the ductus arteriosus, noting its role in diverting blood from the pulmonary to systemic circulation in fetal life. The document outlines conditions of ductus dependent pulmonary and systemic blood flow. It discusses goals of management as minimizing hypoxemia and balancing pulmonary and systemic circulations. Maintaining ductal patency with prostaglandins is emphasized as critical for stabilization in ductus dependent lesions.
This document provides question and answer summaries from an OSCE exam in pediatrics. It includes 20 stations covering topics like lung lobe and segment identification, developmental screening tools, interpreting blood gases and X-rays, diagnoses for various clinical presentations, and questions on management of conditions like anaphylaxis, scurvy, pulmonary vasculitis, cystic fibrosis and more. Treatment, investigations, genetic causes are discussed. The last few stations address questions on secondary prophylaxis for rheumatic fever.
Pernicious malaria is a severe form of Plasmodium falciparum malaria that can threaten a patient's life within 1 to 3 days if not treated effectively. It results from capillary blockage caused by the agglutination of parasitized erythrocytes in the blood vessels of internal organs. This leads to decreased blood flow and volume. Manifestations include cerebral malaria with coma and paralysis, algid malaria with cold skin and circulatory failure, and septicemic malaria with high fever, pneumonia and cardiac issues. Pathology findings include brain, gastrointestinal tract, and lung tissue damage from congested capillaries filled with parasitized red blood cells.
Here are three more potential causes of paralysis in patients with AIDS:
- Cryptococcal meningitis: The most common fungal infection of the CNS in AIDS patients. Can cause increased intracranial pressure, cranial neuropathies, and spinal cord compression.
- Progressive multifocal leukoencephalopathy (PML): Caused by JC virus reactivation in AIDS patients. Presents with cognitive impairment, visual changes, and sometimes motor deficits. MRI often shows multifocal white matter lesions.
- Vacuolar myelopathy: Caused by HIV itself. Presents with spastic paraparesis. MRI may show T2 hyperintensities in the lateral and posterior columns of the spinal cord. Treat
This document provides an overview of inborn errors of metabolism (IEM). It discusses that IEM have an overall incidence of 1 in 1000 to 1 in 2000 births. The most common presentation is sepsis in 30% of cases. IEM are classified based on the defective metabolic pathway, such as amino acid metabolism defects, carbohydrate metabolism defects, and organic acidemias. Clinical pointers for suspected IEM include deterioration after apparent normalcy, hypoglycemia, metabolic acidosis, abnormal urine odor, and dysmorphic features. Evaluation of neonates involves blood tests, blood gases, glucose and ammonia levels, urine analysis, and plasma amino acid analysis to identify specific disorders. Management involves identifying and limiting the offending substance
Delayed blood transfusion reaction is a reaction too blood transfusion occurring after 24 hours. Can be divided to immune mediated and non-immune mediated. Share about the cause, symptoms, investigations and management.
This is a comprehensive review of the physiology and pathophysiology of iron deficiency anemia and the evolution of its treatment with parenteral iron to the current recommendations. In our practice, in an attempt to minimize allogenic blood transfusions, we optimize preoperatively patients with iron deficiency anemia by means if intravenous iron replacement.
The document discusses guidelines for initiating insulin therapy in patients with type 2 diabetes not controlled on oral antidiabetic drugs (OADs). It recommends starting with either bedtime intermediate-acting insulin or bedtime or morning long-acting insulin, beginning at a dose of 10 units or 0.2 units/kg. The insulin dose is then titrated up based on fasting blood glucose levels until the target range is achieved. Additional injections of rapid-acting insulin may be added if pre-meal blood glucose levels remain out of range.
Approach to a child with HepatosplenomegalySunil Agrawal
This document discusses hepatosplenomegaly, or the enlargement of the liver and spleen. It begins with an introduction and overview of hepatomegaly and splenomegaly. It then covers the various causes of hepatosplenomegaly including infections, hematological disorders, vascular congestion, tumors and infiltrations, storage disorders, and miscellaneous causes. The document provides details on evaluating a patient's history, physical examination findings, investigations, and treatment strategies for hepatosplenomegaly in both children and neonates. It concludes with references for further information.
Tetralogy of Fallot is a congenital heart defect characterized by four abnormalities: pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and overriding of the aorta. It occurs in approximately 1 in 2,500 live births. Without treatment, it can cause cyanosis and heart failure in infants. The definitive treatment is open-heart surgery to repair the abnormalities. After successful surgery, patients typically enjoy an active life without symptoms.
Chronic granulomatous disease is a rare inherited disorder characterized by defects in the NADPH oxidase system, which leads to recurrent infections. It is caused by mutations affecting components of the NADPH oxidase enzyme complex, resulting in the inability of phagocytes to produce reactive oxygen species to kill certain bacteria and fungi. Patients present with recurrent infections of the lungs, skin, lymph nodes, liver or bones by catalase-positive organisms. Treatment involves lifelong antibiotic prophylaxis, with hematopoietic stem cell transplantation or gene therapy as curative options.
The document discusses various pediatric arrhythmias including tachycardias and bradycardias. It provides details on normal heart rates at different ages and describes common supraventricular tachycardias like AV nodal reentrant tachycardia, accessory pathway mediated tachycardias. It also discusses idiopathic ventricular tachycardia and management strategies for different arrhythmias including medication and ablation. Congenital complete heart block is described along with its association with maternal autoimmune conditions.
This document discusses drug-induced liver injury (DILI) caused by anti-tuberculosis (ATT) drugs. It notes that ATT drugs, particularly isoniazid, rifampin, and pyrazinamide, are common causes of DILI. Isoniazid metabolism varies depending on acetylator status, and its toxicity may be due to reactive metabolites. Rifampin induces liver enzymes and its toxicity is often seen in combination with other ATT drugs. Pyrazinamide toxicity depends on dose and can cause fatty liver. Presentations of ATT-induced DILI range from asymptomatic elevations in enzymes to acute liver failure. Careful screening and monitoring of patients on ATT is needed to prevent DILI
This document discusses basics of insulin therapy including:
- The discovery of insulin in the 1920s and types of insulin including basal, mealtime, premixed, and newer combinations.
- Insulin action profiles, indications for insulin use, administration techniques using vials, syringes and pens, and common insulin regimens for type 2 diabetes including once or twice daily basal insulin +/- mealtime insulin or premixed insulin.
- Proper storage, mixing, and injection of insulin as well as recommended sites for injection are also reviewed.
Sodium glucose co transporter( SGLT2) Inhibitors Philip Vaidyan
This document discusses sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of drugs for treating type 2 diabetes. SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, increasing urinary glucose excretion in a glucose-dependent manner. Three SGLT2 inhibitors have been approved by the FDA - canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors offer advantages over other anti-diabetic drugs in that they are non-insulin dependent and can be used throughout the course of diabetes. However, long-term safety studies are still needed to fully assess their risk-benefit profile.
This document discusses antiplatelet drug resistance in Asian populations. It covers several topics:
- Aspirin and clopidogrel resistance, their types and mechanisms. Genetic polymorphisms can impact drug metabolism and effectiveness.
- Laboratory tests to identify resistance, including platelet function tests and genetic testing to identify variants affecting drug metabolism.
- Factors that can influence drug resistance, such as medication compliance, drug interactions, and genetic factors affecting metabolic pathways.
- Management strategies depending on the resistance type, such as increasing drug doses or trying alternative medications.
Dr. Arun Karmakar presented on hyponatremia. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder. It is clinically important because acute severe hyponatremia can cause morbidity and mortality, and outcomes are worse in hyponatremic patients with underlying diseases. Hyponatremia can be hypovolemic, euvolemic, or hypervolemic depending on water and sodium levels. Treatment depends on the severity and cause of hyponatremia, with aggressive correction for symptomatic cases and slower correction for chronic cases to avoid osmotic demyelination syndrome.
This document discusses opportunistic infections (OIs) that occur in patients with AIDS. It defines AIDS according to CDC and NACO criteria involving OIs or low CD4 counts. Common OIs seen in India are described such as tuberculosis, candidiasis, cryptosporidiosis, herpes zoster, toxoplasmosis, and Pneumocystis pneumonia. Symptoms, diagnosis, and treatment of these OIs are outlined. The role of patient education in prevention and treatment adherence is also discussed.
Sick Euthyroid Syndrome refers to abnormal thyroid function test results that occur during non-thyroidal illness without pre-existing thyroid dysfunction. It is characterized by low T3 and elevated reverse T3 levels. This pattern results from impaired conversion of T4 to T3 in tissues due to reduced activity of deiodinase enzymes from cytokines. The severity of the thyroid hormone changes correlates with the severity of the underlying illness. Treatment with thyroid hormone is controversial, and thyroid function usually normalizes as the illness improves.
Septicemia international management guidelineNeurologyKota
This document provides guidelines for the management of sepsis and septic shock. It defines key terms like sepsis, severe sepsis, septic shock, and systemic inflammatory response syndrome. It outlines variables for diagnosis and assessing organ dysfunction. It recommends initial resuscitation goals within 3-6 hours including measuring lactate, administering antibiotics and fluids, and applying vasopressors if needed. It provides guidelines for diagnosis, source control, antibiotic therapy, fluid therapy, vasopressor use, and other supportive treatments. Recommendations are evidence-based with assigned grade levels.
El documento propone el proyecto "Septicemia Club" para recolectar historias locales de Colombia a través de una plataforma web. El proyecto busca reunir estas historias desconocidas, crear versiones unificadas de historias similares, y publicarlas semanalmente en formatos de audio y escrito para preservar la identidad cultural colombiana y promover la tradición narrativa local.
This document provides an overview of inborn errors of metabolism (IEM). It discusses that IEM have an overall incidence of 1 in 1000 to 1 in 2000 births. The most common presentation is sepsis in 30% of cases. IEM are classified based on the defective metabolic pathway, such as amino acid metabolism defects, carbohydrate metabolism defects, and organic acidemias. Clinical pointers for suspected IEM include deterioration after apparent normalcy, hypoglycemia, metabolic acidosis, abnormal urine odor, and dysmorphic features. Evaluation of neonates involves blood tests, blood gases, glucose and ammonia levels, urine analysis, and plasma amino acid analysis to identify specific disorders. Management involves identifying and limiting the offending substance
Delayed blood transfusion reaction is a reaction too blood transfusion occurring after 24 hours. Can be divided to immune mediated and non-immune mediated. Share about the cause, symptoms, investigations and management.
This is a comprehensive review of the physiology and pathophysiology of iron deficiency anemia and the evolution of its treatment with parenteral iron to the current recommendations. In our practice, in an attempt to minimize allogenic blood transfusions, we optimize preoperatively patients with iron deficiency anemia by means if intravenous iron replacement.
The document discusses guidelines for initiating insulin therapy in patients with type 2 diabetes not controlled on oral antidiabetic drugs (OADs). It recommends starting with either bedtime intermediate-acting insulin or bedtime or morning long-acting insulin, beginning at a dose of 10 units or 0.2 units/kg. The insulin dose is then titrated up based on fasting blood glucose levels until the target range is achieved. Additional injections of rapid-acting insulin may be added if pre-meal blood glucose levels remain out of range.
Approach to a child with HepatosplenomegalySunil Agrawal
This document discusses hepatosplenomegaly, or the enlargement of the liver and spleen. It begins with an introduction and overview of hepatomegaly and splenomegaly. It then covers the various causes of hepatosplenomegaly including infections, hematological disorders, vascular congestion, tumors and infiltrations, storage disorders, and miscellaneous causes. The document provides details on evaluating a patient's history, physical examination findings, investigations, and treatment strategies for hepatosplenomegaly in both children and neonates. It concludes with references for further information.
Tetralogy of Fallot is a congenital heart defect characterized by four abnormalities: pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and overriding of the aorta. It occurs in approximately 1 in 2,500 live births. Without treatment, it can cause cyanosis and heart failure in infants. The definitive treatment is open-heart surgery to repair the abnormalities. After successful surgery, patients typically enjoy an active life without symptoms.
Chronic granulomatous disease is a rare inherited disorder characterized by defects in the NADPH oxidase system, which leads to recurrent infections. It is caused by mutations affecting components of the NADPH oxidase enzyme complex, resulting in the inability of phagocytes to produce reactive oxygen species to kill certain bacteria and fungi. Patients present with recurrent infections of the lungs, skin, lymph nodes, liver or bones by catalase-positive organisms. Treatment involves lifelong antibiotic prophylaxis, with hematopoietic stem cell transplantation or gene therapy as curative options.
The document discusses various pediatric arrhythmias including tachycardias and bradycardias. It provides details on normal heart rates at different ages and describes common supraventricular tachycardias like AV nodal reentrant tachycardia, accessory pathway mediated tachycardias. It also discusses idiopathic ventricular tachycardia and management strategies for different arrhythmias including medication and ablation. Congenital complete heart block is described along with its association with maternal autoimmune conditions.
This document discusses drug-induced liver injury (DILI) caused by anti-tuberculosis (ATT) drugs. It notes that ATT drugs, particularly isoniazid, rifampin, and pyrazinamide, are common causes of DILI. Isoniazid metabolism varies depending on acetylator status, and its toxicity may be due to reactive metabolites. Rifampin induces liver enzymes and its toxicity is often seen in combination with other ATT drugs. Pyrazinamide toxicity depends on dose and can cause fatty liver. Presentations of ATT-induced DILI range from asymptomatic elevations in enzymes to acute liver failure. Careful screening and monitoring of patients on ATT is needed to prevent DILI
This document discusses basics of insulin therapy including:
- The discovery of insulin in the 1920s and types of insulin including basal, mealtime, premixed, and newer combinations.
- Insulin action profiles, indications for insulin use, administration techniques using vials, syringes and pens, and common insulin regimens for type 2 diabetes including once or twice daily basal insulin +/- mealtime insulin or premixed insulin.
- Proper storage, mixing, and injection of insulin as well as recommended sites for injection are also reviewed.
Sodium glucose co transporter( SGLT2) Inhibitors Philip Vaidyan
This document discusses sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of drugs for treating type 2 diabetes. SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, increasing urinary glucose excretion in a glucose-dependent manner. Three SGLT2 inhibitors have been approved by the FDA - canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors offer advantages over other anti-diabetic drugs in that they are non-insulin dependent and can be used throughout the course of diabetes. However, long-term safety studies are still needed to fully assess their risk-benefit profile.
This document discusses antiplatelet drug resistance in Asian populations. It covers several topics:
- Aspirin and clopidogrel resistance, their types and mechanisms. Genetic polymorphisms can impact drug metabolism and effectiveness.
- Laboratory tests to identify resistance, including platelet function tests and genetic testing to identify variants affecting drug metabolism.
- Factors that can influence drug resistance, such as medication compliance, drug interactions, and genetic factors affecting metabolic pathways.
- Management strategies depending on the resistance type, such as increasing drug doses or trying alternative medications.
Dr. Arun Karmakar presented on hyponatremia. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder. It is clinically important because acute severe hyponatremia can cause morbidity and mortality, and outcomes are worse in hyponatremic patients with underlying diseases. Hyponatremia can be hypovolemic, euvolemic, or hypervolemic depending on water and sodium levels. Treatment depends on the severity and cause of hyponatremia, with aggressive correction for symptomatic cases and slower correction for chronic cases to avoid osmotic demyelination syndrome.
This document discusses opportunistic infections (OIs) that occur in patients with AIDS. It defines AIDS according to CDC and NACO criteria involving OIs or low CD4 counts. Common OIs seen in India are described such as tuberculosis, candidiasis, cryptosporidiosis, herpes zoster, toxoplasmosis, and Pneumocystis pneumonia. Symptoms, diagnosis, and treatment of these OIs are outlined. The role of patient education in prevention and treatment adherence is also discussed.
Sick Euthyroid Syndrome refers to abnormal thyroid function test results that occur during non-thyroidal illness without pre-existing thyroid dysfunction. It is characterized by low T3 and elevated reverse T3 levels. This pattern results from impaired conversion of T4 to T3 in tissues due to reduced activity of deiodinase enzymes from cytokines. The severity of the thyroid hormone changes correlates with the severity of the underlying illness. Treatment with thyroid hormone is controversial, and thyroid function usually normalizes as the illness improves.
Septicemia international management guidelineNeurologyKota
This document provides guidelines for the management of sepsis and septic shock. It defines key terms like sepsis, severe sepsis, septic shock, and systemic inflammatory response syndrome. It outlines variables for diagnosis and assessing organ dysfunction. It recommends initial resuscitation goals within 3-6 hours including measuring lactate, administering antibiotics and fluids, and applying vasopressors if needed. It provides guidelines for diagnosis, source control, antibiotic therapy, fluid therapy, vasopressor use, and other supportive treatments. Recommendations are evidence-based with assigned grade levels.
El documento propone el proyecto "Septicemia Club" para recolectar historias locales de Colombia a través de una plataforma web. El proyecto busca reunir estas historias desconocidas, crear versiones unificadas de historias similares, y publicarlas semanalmente en formatos de audio y escrito para preservar la identidad cultural colombiana y promover la tradición narrativa local.
12 bio265 disease of circulatory system instructor dr di bonaventuraShabab Ali
This document discusses various microbial pathogens that can cause cardiovascular and systemic diseases. It describes how bacteria, viruses, protozoa and helminths can infect the bloodstream (septicemia) and spread throughout the body, potentially infecting multiple organ systems. Examples discussed in detail include bacteremia, viral infections like Epstein-Barr virus and cytomegalovirus, and parasitic diseases such as toxoplasmosis, malaria, Chagas disease, schistosomiasis and others. For each pathogen, the document outlines the causative agent, transmission, signs and symptoms, diagnosis and available treatments.
Este documento discute la sepsis, una respuesta inflamatoria sistémica a la infección que puede causar disfunción multiorgánica y choque séptico. Señala que la sepsis no se diagnostica adecuadamente en Chile, lo que impide contar con estadísticas completas. Explica que la liberación de mediadores proinflamatorios durante la sepsis puede causar daño vascular e hipoperfusión tisular. También describe los síntomas primarios y complicaciones de la sepsis, así como las estrategias de tratamiento como fluidoterapia, uso de inot
The document discusses sepsis, septicemia, and related conditions. It defines sepsis as a clinical syndrome caused by infection plus a systemic inflammatory response. Septicemia is the presence of bacteria in the bloodstream (bacteremia), which if untreated can progress to sepsis. Common causative organisms are E. coli, Streptococcus, and Staphylococcus. Risk factors include young, elderly, immunosuppressed individuals, and those with injuries or medical devices. Symptoms may include fever, low blood pressure, and signs of infection in various organs. Blood cultures and clinical assessments are used to diagnose septicemia. Immediate treatment involves antibiotics and IV fluids.
This document discusses SIRS, sepsis, septicemia, and septic shock. SIRS is defined as having two or more symptoms like fever, increased heart rate, increased breathing rate, and abnormal white blood cell count. Sepsis occurs when SIRS is caused by a confirmed infection. Septic shock is sepsis combined with low blood pressure despite fluid resuscitation. The document outlines signs of septic shock and multiple organ dysfunction syndrome (MODS), common infectious etiologies, clinical features, investigations for diagnosis, and general treatment and prognosis.
Septicemia is a life-threatening blood infection caused by bacteria entering the bloodstream from a site of infection. Common symptoms include fever, rapid breathing/heartbeat, low blood pressure, and mental confusion. Bacteria such as E. coli, streptococcus pneumoniae, and salmonella are often involved. The document details types, causes, diagnosis, and treatment of septicemia, including antibiotics and supportive care. It concludes by emphasizing the importance of preventing and promptly treating infections to avoid septicemia.
Multi drug resistant bacteria are a big problem in ICUs now a days. This is a successful case report where we treated an pleural infection b directly instilling the drug colistin in the pleura.
This document discusses nosocomial infections (NCI) and multi-drug resistant organisms (MDRO). It defines NCI as infections acquired in a hospital setting and notes factors contributing to rising NCI rates include emerging MDROs, crowded hospitals, and immunocompromised patients. Common routes of transmission and sites of infection are described. Examples of prevalent MDROs are provided, such as MRSA, ESBL-producing bacteria, carbapenem-resistant enterobacteriaceae, Acinetobacter baumannii, and others. The role of clinical microbiology laboratories in identifying pathogens and detecting drug resistance is highlighted. Prevention strategies like isolation, sterilization, handwashing and personal protective equipment are recommended.
This study analyzed 321 infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria at a hospital in Rhode Island from 2006-2011. The number of such infections increased each year. While Klebsiella pneumoniae was previously dominant, there was a shift to Escherichia coli as the predominant organism. Resistance to common oral antibiotics was high. A comparison with studies in Pakistan found similar high resistance levels in ESBL-producing E. coli isolates from hospitalized patients in Islamabad and Peshawar.
Newer antibiotics for resistant gram +ve infections in icuDR.pankaj omar
1) Gram-positive bacteria are common causes of infection in ICUs and the community. There is an increasing prevalence of drug-resistant strains like MRSA, VRE, and C. difficile which limits treatment options and increases mortality.
2) Common gram-positive pathogens discussed include S. aureus, enterococci, streptococci, and C. difficile. Their transmission and risk factors are outlined. Prevention strategies focus on antimicrobial stewardship, infection control measures like contact precautions, and environmental disinfection.
3) Newer antibiotics discussed that have activity against resistant gram-positive bacteria include linezolid, daptomycin, tigecycline, and ceftobiprole
The document discusses the history and early studies of transfer factors, which are immune system regulators found in colostrum that can transfer immunity. Early studies showed transfer factors from blood were effective against various infections and diseases but posed contamination risks. Researchers then found transfer factors in bovine colostrum that were non-species specific and more effective. Later studies showed bovine colostrum transfer factors reduced relapse in Burkitt's lymphoma, showed preliminary benefits for AIDS patients, and helped treat recurrent cystitis.
Enterococcus cecorum infections were identified in two critically ill children and two adult septic patients using 16S rRNA gene sequencing. E. cecorum was detected in the blood of two adults with sepsis and in the cerebrospinal fluid of two children with ventriculitis. Biomarkers indicated active infection in the patients. While other pathogens were also present in two cases, E. cecorum was identified as a potential pathogen. Exposure to farm animals was suspected as the source of infection for the rural patients. Notably, transmission from mother to newborn was hypothesized in one case, suggesting potential for human-to-human spread. 16S rRNA sequencing was crucial for identification of E. cecorum,
Pseudomembranous colitis is caused by Clostridium difficile bacteria and is usually associated with antibiotic use. The bacteria releases toxins that damage the colon lining, causing symptoms like severe diarrhea. Risk factors include advanced age, hospitalization, and immunosuppression. Treatment involves stopping the culprit antibiotic if possible, rehydration, and antibiotic therapy targeted against C. difficile like vancomycin. Complications can include dehydration, perforation, and toxic megacolon requiring surgery in some cases.
ABSTRACT- Urinary Tract Infections (UTI) is a major threat to human health. It is caused due to various physiological changes of the urinary tract by the activity of microorganisms. Urinary Tract infections has also been a major type of hospital acquired infection. Hospital acquired infections (HAI) are of various types: Respiratory Tract Infection (RTI), Urinary Tract Infection (UTI), Blood Stream Infection (BSI), and Surgical Site Infection (SSI) and the most common are Urinary Tract (39%) and Respiratory Tract (20-22%) infection. The main aim of this study was to assess various urine samples collected from patients of the ICU of a tertiary care hospital for microbial growth and create a statistical picture on the contribution of UTI to nosocomial infections. Certain governing factors for UTI like presence of pus cells, epithelial cells, and diabetes mellitus were also kept under consideration along with various patient details like age, sex, primary illness and prior antibiotic treatment. The key findings of the study were: the
mean age of patients with symptomatic and asymptomatic UTI was 51 years and people from both genders within the age group of 41-60 were equally susceptible. E. coli was the most common causative organism (35.7%) followed by Citrobacter (21.42%) and Klebsiella (14.28%). Other organisms included Pseudomonas, Enterococcus and Candida. The rate of UTI was 56.22/1000 days of catheterization. Most of the organisms isolated were found to be multi drug resistant. UTI has been hence concluded to play a major contribution in nosocomial infections which needs to be controlled by integrating proper monitoring of hospital data and surveillance of hospital acquired urinary tract infection.
Key-words- ICU, Urinary Tract Infection, Center for Disease Control, Multi drug resistant, antibiotics, Microorganism
Combating Drug Resistance in The Intensive Care Unit (ICU)Apollo Hospitals
Drug resistance of microbes has become a major challenge in treating ICU patients successfully. There are many factors that contribute to the development of drug resistance, including irrational antibiotic use, lack of antibiotic stewardship programs, and poor infection control practices. Implementing strict antibiotic policies, having responsive microbiology departments, and educating healthcare providers on following clinical guidelines are important first steps to prevent drug resistance. It is also essential to monitor antibiotic use, tailor therapies based on culture results, and withdraw antibiotics appropriately once infections have resolved. A multifaceted approach involving hospitals, healthcare workers, and communities is needed to curb the growing issue of antimicrobial resistance.
This study analyzed blood cultures from neonatal intensive care unit patients from 1997 to 2001 in Tripoli Medical Center, Libya. A total of 1431 blood culture sets from 1092 patients were positive for bacterial growth in 801 sets, representing 648 cases of neonatal bacteraemia. The most common causative agents were members of the Enterobacteriaceae family including Serratia, Klebsiella, and Enterobacter species as well as coagulase-negative and positive Staphylococci. Antibiotic susceptibility testing found high levels of resistance among the most frequent pathogens, though resistance to newer antibiotics like aztreonam and imipenem was less common. Resistance in Staphylococcus to anti-stap
Prevalence of Urinary Tract Infection among Patients with Diabetes Melitus in...MCMScience
Background: & Objectives: Urinary tract infection is one of the most commonly occurring infections among the patients with diabetes mellitus.
Methods This investigation was based to evaluate the incidence of UTI in patients with DM. Between January, 2013 to November, 1000 diabetic urine samples were collected. All urine samples were processed in the lab following standard laboratory protocol.
Results: A total of 25 UTI organisms were isolated from 361 urine samples collected from the diabetic patients attending the Department of Emergency, University Hospital Center "Mother Theresa” (QSUT) from. The incidence of UTI was recorded to 36.1%. Escherichia coli (54%) was found to be the major cause of UTI. About 5 different types of organisms isolated from the UTI samples were randomly chosen to test against the UTI antibiotics.
Interpretation & Conclusion: The antibiotic susceptibility pattern revealed that ciprofloxacin and nitrofurantoin were most effective to e.coli 79.6%, and 89.4%. These data may be used to determine trends in antimicrobial susceptibilities, to formulate local antibiotic policies and to assist clinicians in the choice of antibiotic therapy to prevent misuse, or overuse of antibiotics.
Key Words: Diabetes mellitus (DM), Urinary Tract Infection (UTI), Bacteria, antimicrobial resistance
Caso clinico 2, Kpc klebsiella. angelica ramirezSami Beltran
This study identified the first case of a KPC-producing Klebsiella pneumoniae isolate in Singapore. Rectal screening of 201 patients identified one KPC-producing K. pneumoniae isolate. Genetic analysis found the isolate carried blaKPC-2 and belonged to the globally disseminated ST11 clone. The isolate was obtained from an elderly woman in the local community with no recent travel or antimicrobial drug use, suggesting potential community acquisition and dissemination. Widespread screening and infection control are needed to prevent further spread of this multidrug resistant organism between hospitals and long-term care facilities.
This study identified the first case of a KPC-producing Klebsiella pneumoniae isolate in Singapore. Rectal screening of 201 patients identified one KPC-producing K. pneumoniae isolate. Genetic analysis found the isolate carried blaKPC-2 and belonged to the globally disseminated ST11 clone. The isolate was obtained from an elderly woman in the local community with no recent travel or antimicrobial drug use, suggesting potential community acquisition and dissemination. The identification of this first KPC-producing isolate highlights the need for coordinated infection control between hospitals and long-term care facilities.
and Two Case Stories with Infective Episodes in Pacemaker Treated Patients.pdfMonica Franklin
1) The document describes two cases of infective episodes in pacemaker-treated patients caused by Cardiobacterium hominis and Cardiobacterium valvarum.
2) In the first case, C. hominis was cultured from blood samples taken two years apart, with a vegetation later found on the pacemaker lead requiring its removal.
3) The second case involved C. valvarum and a large vegetation on the aortic valve, treated with antibiotic therapy and valve replacement surgery.
This document reports a case study of a patient successfully treated for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection with a combination of meropenem and colistin. The patient was initially treated with various antibiotics for hospital-acquired pneumonia and developed a CRKP infection. Treatment with meropenem alone was considered insufficient. The combination of meropenem and colistin showed effectiveness against the infection and led to resolution of symptoms and negative cultures. The study demonstrates the challenges of treating multi-drug resistant infections and supports the use of combination antibiotic therapy in some cases.
Austin Immunology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Immunology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Immunology. Austin Immunology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of immunology.
Austin Immunology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Two cases of peritonitis caused by Pantoea species in peritoneal dialysis patients are presented with different outcomes. In the first case, the source was likely contact with basil plants and the patient responded well to antibiotics. In the second case, the source was unknown and the patient did not improve with antibiotics, requiring catheter removal. Pantoea species is an uncommon but increasingly reported cause of peritonitis. While most cases respond to antibiotics, some may require more invasive treatment like catheter removal if no improvement is seen.
Typhoid fever is caused by Salmonella typhi bacteria and results in a continuous fever for 3-4 weeks. It is estimated to cause over 21 million cases and 200,000-600,000 deaths globally each year. In India in 2011 there were over 1 million reported cases and 346 deaths. The disease is transmitted through contaminated food or water via the fecal-oral route. Diagnosis involves isolating S. typhi from blood or stool samples or detecting antibodies. Control methods include proper sanitation, identifying and treating carriers, immunizing at-risk populations, and isolating infected individuals.
Preventive and therapeutic strategies in critically ill patients with highly...Sergio Paul Silva Marin
This document discusses preventive and therapeutic strategies for critically ill patients infected with highly resistant bacteria. It notes that antibiotic resistance is a major global problem, with multidrug-resistant and pandrug-resistant organisms increasingly encountered in healthcare settings. The review focuses on strategies for severely ill ICU patients, who are at high risk of nosocomial infections due to medical advances enabling longer stays. Timely diagnosis and optimized antibiotic treatment are important for managing such infections.
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Improved Patient Satisfaction At Apollo – A Case StudyApollo Hospitals
1) Indraprastha Apollo Hospital utilized patient satisfaction surveys called Voice of Customer (VOC) tools to identify ways to improve various hospital departments and services.
2) Factors that contributed to an increasing trend in VOC scores over 1.5 years included leadership commitment to quality improvement, improved efficiency, superior clinical care, soft skills enhancement for staff, and improved patient information and complaint resolution.
3) Through consistent efforts such as staff training, improved processes, and addressing issues identified in VOC surveys, Apollo Hospitals achieved higher than target patient satisfaction scores, creating loyal patients with memorable hospital experiences.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
A 34-year-old woman presented with accidental ingestion of mercury that was used in her household to preserve grains. She experienced abdominal radiopaque shadows on X-ray that cleared after two days. Mercury poisoning can result from inhalation, ingestion, or absorption and affects the neurological, gastrointestinal, and renal systems. Diagnosis involves determining exposure history and elevated mercury levels in blood and urine. Supportive treatment includes removal of contaminated materials, irrigation, activated charcoal, chelation agents, and hemodialysis in severe cases.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
This document describes two cases of unusual manifestations of dengue fever. Case 1 is a 40-year-old man who presented with fever, headache, body aches, and a rash who developed hepatitis, thrombocytopenia, and respiratory distress from dengue hemorrhagic fever. Case 2 is a 24-year-old man who presented with fever and was found to have an intraocular hemorrhage, retinal detachment, ARDS, myocarditis, and hepatitis, also from dengue hemorrhagic fever. The document then reviews atypical neurological and gastrointestinal manifestations that have been reported with dengue infection.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
This document discusses pediatric liver transplantation. It begins by stating that pediatric liver transplantation is now an established treatment for end-stage liver failure from various causes, with excellent results due to improved immunosuppressive regimens, surgical techniques, and intensive care. It then discusses the historical development of liver transplantation, including the first attempts in the 1960s and key innovations like cyclosporine in the 1980s. The most common indications for pediatric liver transplantation are discussed as extrahepatic biliary atresia and acute liver failure. The document provides an overview of the pre-transplant evaluation process and post-transplant medical management and immunosuppression. It notes that living-related transplantation has helped address the shortage of donor l
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.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
3. 116 a p o l l o me d i c i n e 1 1 ( 2 0 1 4 ) 1 1 5 e1 1 8
2. Case report
2.1. Case 1
An 18-year-old female patient suffering from refractory
Hodgkin's lymphoma (STAGE IV B) underwent autologous
bone marrow transplant (BMT). She was put on immunosup-pressive
therapy with tacrolimus and mycophenolate mofetil
to prevent graft rejection. She engrafted successfully initially
with neutrophil on day 9th followed by platelets on day 12th
post transplant. On day 10th post transplant she became
septic and was managed with broad spectrum antibiotics
meropenem and teicoplanin after sending samples for cul-ture.
Both the aerobic blood culture and urine culture samples
showed growth of gram negative bacilli. The isolates were
oxidase positive, non-motile and non-fermenter. Further
identification and sensitivity was done in VITEK 2C (Bio-merieux)
automated system. The isolates were identified as E.
meningoseptica .The isolates were sensitive only to levofloxacin
[Minimum Inhibitory Concentration (MIC) 2 mg/ml] when
tested in VITEK using AST N090 cards and were resistant to all
other commonly used antibiotics. E. meningoseptica was also
isolated from the throat swab of this patient during routine
pre-transplant surveillance. In view of the above findings
levofloxacin was added. Subsequently blood culture became
sterile. On day 15th post transplant the patient developed
severe respiratory distress and had to be intubated and
ventilated to support her respiratory functions. A broncho-alveolar
lavage was performed at that time. BAL fluid culture
also showed heavy growth of E. meningoseptica. But she
continued to have repeated episodes of respiratory distress
and her condition deteriorated and was shifted to the ICU
(Intensive Care Unit). Levofloxacin was discontinued and
vancomycin, trimethoprim/sulphamethoxazole and rifam-picin
(drugs which are effective against E. meningoseptica ac-cording
to various literature.) were started on day 22 post
transplant. Urine culture still showed growth of E. meningo-septica
and Chest X ray had persistent infiltrates. Vancomycin
was added on day 30th post transplant since it is reported to
have therapeutic effect on E. meningoseptica .After about a
week of above therapy the patient started improving and
thereafter E. meningoseptica was not isolated from any of the
clinical samples. Rifampicin and trimethoprim/sulphame-thoxazole
was continued for 10 more days and thereafter
rifampicin was stopped and trimethoprim/sulphamethox-azole
was continued for one month. Vancomycin was
administered for a week. Her condition improved gradually
and she was extubated on Day 37 post transplant and
remained well with minimum oxygen requirement.
2.2. Case 2
A 25-year-old patient following caesarean section two days
back was admitted to the hospital with abdominal pain and
distention. The CAT scan of abdomen revealed severe acute
pancreatitis (Balthazer E, CTSI 4/10) along with blood clots in
pelvis with pleural and peritoneal effusion. At the time of
admission she had features of disseminated intra vascular
coagulation (DIC) for which she was treated with fresh frozen
plasma. She underwent surgical intervention for removal of
pelvic blood clots and adhesionolysis. But despite her
pancreatitis and coagulation parameters improving, her con-dition
worsened and she developed fever and respiratory
distress and was put on mechanical ventilation on day 10th of
hospitalization. She started having spikes of high tempera-ture.
Suspecting sepsis with multidrug resistant bacteria she
was empirically treated with polymyxin B, teicoplanin and
caspofungin. Her chest X-ray showed presence of bilateral
infiltrates. Blood and Endotracheal (E.T) secretion sent for
culture showed growth of E. meningoseptica. The isolate was
moderately sensitive to levofloxacin (MIC 4 mg/ml) and resis-tant
to other antibiotics such as quinolones, beta lactams,
aminoglycosides, trimethoprim/sulphamethoxazole, doxycy-cline.
Following the isolation of E. meningoseptica the poly-myxin
B was substituted with rifampicin and trimethoprim/
sulphamethoxazole. A repeat blood culture sent three days
later again showed growth of E. meningoseptica. Gradually the
patient started improving and she was extubated four days
after starting E. meningoseptica specific antibiotics. The rifam-picin
was continued for two weeks and trimethoprim/sul-phamethoxazole
was continued for a total of three weeks.
Repeat blood and urine cultures after 14 days were sterile and
the patient was discharged in a haemodynamically stable
condition.
3. Discussion
E. meningoseptica used to be implicated as a cause of infection
in neonates. The literature is replete with cases of E. menin-goseptica
primarily in pediatric patients with neonates in
particular.3 E. meningoseptica is a well known cause of neonatal
meningitis particularly in premature infants and often occurs
as outbreaks with a very high mortality rate.4 But recent
literature search has shown that E. meningoseptica is emerging
as a cause of infection in hospitalized adults as well. In adults
E. meningoseptica has been mainly responsible for blood stream
and respiratory infection unlike pediatric patients where
meningitis is the most common presentation.2 In adults E.
meningoseptica is increasingly being reported as a cause of
nosocomial infection in immunocompromised hosts. Respi-ratory
infection in adults is mostly associated with mechani-cal
ventilation.5
In both the above mentioned cases the patients were
immunocompromised e one being a BMT recipient heavily on
immunosuppressant therapy and the other was a patient with
multiorgan involvement in the form of pancreatitis, acute
respiratory distress syndrome, and DIC with multiple blood
transfusions.
Respiratory route seems to be the portal of entry of the
bacteria .Both our patients had severe chest infection and E.
meningoseptica was isolated from BAL (Broncho Alveolar
Lavage) and E.T secretion in significant numbers.
In the first case E. meningoseptica was isolated from the
throat swab sample during routine surveillance days before
infection by E. meningoseptica was detected. E. meningoseptica
was also isolated from the tap water of Bone Marrow Trans-plant
unit where the first case initially was admitted.
4. a pol l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 1 5 e1 1 8 117
It is well documented that contaminated respiratory
equipment has been the source of infection in ventilated pa-tients.
6 This may be true for this bacterium as well.
Environmental studies have shown that E. meningoseptica
can survive in chlorinated water supplies, often colonize sink
basins and taps and thus becomes a potential reservoir for
infection in the hospital environment and can infect patients
via contaminated medical devices.7 A recent study by Balm
et al has shown that 44% of taps in the critical care units are
colonized with E. meningoseptica.8
Treatment with E. meningoseptica infection is difficult and
challenging as this organism is inherently resistant to many
antimicrobial agents such as beta lactams including carba-penems
and aztreonam (due to production of beta lactamases
and metallobetalactamases), polymyxins, aminoglycosides,
and chloramphenicol that are the mainstay of treatment for
gram negative sepsis. They are often susceptible to agents
generally used to treat gram positive bacterial infections such
as rifampicin, clindamycin, cotrimoxazole, quinolones and
vancomycin.9 However use of Rifampicin alone in countries
like India where tuberculosis is endemic is not advocated.
The difficulty in treating this infection is compounded by
the fact that MIC breakpoints have not being established for
this bacterium by Clinical and Laboratory Standards Institu-te(
CLSI). Moreover results of susceptibility testing vary when
different methods are used thus adding to the difficulty of
selecting the appropriate antibiotic. Disc diffusion method is
unreliable .The use of inactive drugs may be the cause of poor
outcome in many patients.9
Hsu et al have studied 118 patients with bacteremia and
have concluded that institution of effective antibiotic therapy
after the availability of culture results is an independent
predictor of mortality. They have also shown that E. menin-goseptica
septicemia patients treated with carbapenems have
higher mortality than when they are treated with other anti-biotics
such as fluoroquinolones.10
The SENTRY antimicrobial surveillance programme which
was initiated in 1997 to monitor antimicrobial resistance for
both community acquired and nosocomial infection has
revealed Chryseobacterium strains exhibit resistance to ami-noglycosides,
tetracyclines, chloramphenicol, erythromycin,
clindamycin and teicoplanin.11The same study has shown
that fluoroquinolones have favorable susceptibility pattern
against E. meningoseptica with levofloxacin being slightly more
effective than ciprofloxacin and that the susceptibility to
doxycycline and trimethoprim/sulphamethoxazole appears
variable. Rifampicin and vancomycin in combination has
been used successfully in meningitis cases. But recently in-vestigators
have questioned the usefulness of vancomycin
since in vitro susceptibility data points towards a high MIC of
vancomycin against E. meningoseptica.12,13
In the first case the patient was initially treated with lev-ofloxacin
and subsequently with rifampicin and trimetho-primesulphamethoxazole
and the organism was successfully
eradicated from blood, urine and respiratory samples. In the
second case the cure was affected with rifampicin and tri-methoprimesulphamethoxazole.
Both the patients were
successfully treated with the proper antibiotics after the cor-rect
identification was made. Thus timely identification of E.
meningoseptica is very crucial since appropriate antibiotic
therapy is vital for eradicating infection. All oxidase positive
organism resistant to Polymyxin group (Poly B & Poly E) of
antibiotics should be further characterized. Reporting of all
non-fermenter oxidase positive organisms as Pseudomonas
sp may result in inappropriate antibiotic therapy resulting in
poor outcome. E. meningoseptica septicemia can be life
threatening if not detected and treated with appropriate an-tibiotics.
A study by Lin et al from Taiwan has shown high
mortality of patients with nosocomial bloodstream infection
due to E. meningoseptica. They have further shown that shock
and use of inappropriate antibiotics in these patients are
significantly associated with mortality.14
Isolation of E. meningoseptica should necessitate enhanced
environmental surveillance since E. meningoseptica has the
potential to cause outbreaks and any incriminating source
should be dealt appropriately. In our case flushing of pipelines
and changing of tap faucets resulted in eradication of organ-ism
from the water source and no new infection with E.
meningoseptica was reported.
In conclusions it can be said that E. meningoseptica is an
emerging bacteria causing infection in critically ill adult pa-tients.
The use of Polymyxin group of drugs that are the main
stay of treatment for carbapenem resistant bacteria may have
resulted in the emergence of these intrinsic polymyxin resis-tant
bacteria. Contaminated equipments and water is the
possible source of infection. Infection with E. meningoseptica
necessitates enhanced microbiological surveillance particu-larly
of the water and hand washing sinks so as to be able to
identify the source of the bacteria. Identification of this bac-terium
is difficult and may be wrongly reported as Pseudo-monas
sp. A high index of suspicion should be present in order
to be able to identify this bacterium. Antibiotic therapy is
challenging as E. meningoseptica is intrinsically resistant to
many of the high end antibiotics used in critical care units
particularly Polymyxin group of drugs to which this is intrin-sically
resistant. The currently used CLSI guideline for anti-biotic
susceptibility testing is not helpful for guiding antibiotic
therapy against this organism. Rifampicin, trimetho-primesulphamethoxazole
and levofloxacin alone or in com-bination
seem to be effective against E. meningoseptica.
However the use of Rifampicin alone for the treatment of E.
meningoseptica is to be discouraged. Timely identification and
appropriate therapy is crucial in eradicating this bacterium
and there by improving patients' outcome.
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Bloch KC, Nadarajah R, Jacobs R. Chryseobacterium
meningosepticum: an emerging pathogen among
immunocompromised adults. Report of 6 cases and literature
review. Medicine. 1997;76:30e41.
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