Tuberculoma is a benign, non-cancerous mass caused by a localized tuberculosis infection that most commonly appears in the lungs or brain. It results from infection by the Mycobacterium tuberculosis bacteria. Symptoms vary depending on the location of the tuberculoma but often include headaches, fever, and neurological deficits. Diagnosis involves imaging tests like CT or MRI scans showing characteristic lesions, as well as spinal fluid and tissue analysis. Treatment primarily consists of a prolonged course of multiple antibiotic medications over 9-12 months.
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Or •Bronchiectasis is characterized by permanent, abnormal dilation of one or more large bronchBronchiectasis.
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Or •Bronchiectasis is characterized by permanent, abnormal dilation of one or more large bronchBronchiectasis.
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.
Tetanus Presentation
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Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.
Tetanus Presentation
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Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
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We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
2. Definition
Tuberculomas or tuberculous granulomas are a
well defined focal mass that results from
Mycobacterium tuberculosis infection, and is one of
several morphological forms of tuberculous disease.
3. Tuberculosis of the central nervous system can
result from either haematogenous spread from distant
systemic infection (e.g. pulmonary tuberculosis) or
direct extension from local infection (e.g. tuberculous
otomastoiditis).
4. A tuberculoma is a benign non-neoplastic mass (a
tumor-like mass that is not a cancer) caused by a
localized tuberculosis infection. They are rare even in
patients with tuberculosis, but usually appear in the
lungs or brain. They usually respond to the same
antibiotics used to treat the tuberculosis, but can also
present with complications such as meningitis.
5. Incidence
The incidence of TB is increasing worldwide. Some
reports keep TB as the "leading cause of death due to
a single infectious agent" and the seventh leading
cause of death and disability worldwide.
6. Risk factors
Many factors predispose a person to TB. 95% of their
patients had low social, economic, and nutritional
conditions. CNS tuberculomas are seen in 0.55% to
15% of systemic TB cases, Intracranial tuberculomas
are seen in about 1% of all patients with TB,[6]
whereas intradural spinal tuberculomas are reported
to be 2% to 5% of CNS tuberculomas.[1
7. Types of intracranial tuberculoma
Intracranial manifestations of tuberculosis are protean
and can affect all compartments Manifestations
include:
extra-axial
tuberculous meningitis (leptomeningitis): most
common
tuberculous pachymeningitis: rare
intra-axial
intracranial tuberculous granuloma (tuberculoma)
focal tuberculous cerebritis
intracranial tuberculous abscess
tuberculous rhombencephalitis
8. ETIOLOGY AND PATHOPHYSIOLOGY
TB is an infectious disease caused by the obligate
aerobic bacillus, Mycobacterium tuberculosis.
It is transmitted through inhalation of as few as 1 to
10 aerosolized droplets containing the bacteria. As the
bacteria multiply in the alveoli and macrophages of
the lung, the complex cell-mediated immune response
generates a granulomatous reaction, resulting in a
tubercle and caseating necrosis (a small rounded
lesion with a necrosing center).
9. Its outer waxy capsule makes it more resistant to
destruction. As a result, this bacterium can persist in
old necrotic and calcified lesions and is capable of
reinitiating growth. If the bacteria are not contained,
the infection can be hematogenously spread to other
sites.
10. The location of TB spread to the CNS is directly
related to the pattern of blood flow and usually
spreads to the cerebral hemispheres and basal ganglia
in adults and to the cerebellum in children. The ratio
of intramedullary to intracranial lesions are found to
relate to spinal cord versus brain weight, about 1:42.
Spinal lesions are most often found in the thoracic
spine and often present as subacute cord compression.
11. A tubercle that ruptures in the subarachnoid space
results in TB meningitis, whereas deep lesions cause
tuberculomas or abscesses. The tuberculoma capsule
is composed of fibroblasts, lymphocytes, epithelioid
cells, and Langhans giant cells, and its core is a
necrotic caseous center. When this core liquefies, the
lesion becomes a tuberculous abscess, packed with
AFB. Vascular inflammation, vasculitis, and edema,
which can occur around the lesions, are products of
the immune response and can cause additional clinical
complications.
12. Epidemiology
Tuberculosis remains a leading cause of morbidity
and mortality in the developing world. It may account
for ≈1/6th of the 3 million of global mortality due to
Mycobacterium tuberculosis infection. CNS
involvement is thought to occur in 2-5% of patients
with tuberculosis and up to 15% of those with AIDS-
related tuberculosis .
13. Although CNS involvement by tuberculosis is seen in
all age groups, there is a predilection for younger
patients, with 60-70% of cases occurring in patients
younger than 20 years of age .
In endemic regions, tuberculomas account for as many
as 50% of all intracranial masses .
14. Symptoms
CNS TB presents in many different ways. A patient
may be asymptomatic, have pulmonary symptoms, or
have neurologic deficits alone. As one can see from
the case studies, all of the patients had headaches, but
one had vertigo and another fatigue.
15. CNS TB usually has signs and symptoms of increased
intracranial pressure or space-occupying lesions in the
brain or spine.
Common complaints may include headache, stiff
neck, fever, weight loss, blurry vision, confusion,
lethargy, nausea, vomiting, and, for spinal cord
lesions, lower extremity weakness or bowel or bladder
symptoms.
Signs of meningitis may include altered mental status,
fever, seizure, cranial nerve deficits, papilledema, or
meningismus.
16. Examinations
Patients with tuberculomas will have a physical
examination that is consistent with the location in the
brain of the space-occupying lesion, which may
include cranial nerve deficits, altered mental status,
visual changes, hemiparesis, or seizures. Patients with
spinal cord lesions will have a physical examination
consistent with the location of the lesion in the spinal
cord.
17. CT.SCAN
A CT scan of the brain should be done if there is
suspicion for intracranial or intramedullary TB. The
CT scan should be done with and without contrast.
Immature lesions are hypodense and nonenhancing.
Mature lesions are isodense to hyperdense with solid,
ring, or mixed enhancement.
There is a typical target sign suggestive of TB. CT
findings are similar to that of many other CNS
lesions, including fungal infections, neurosarcoidosis,
bacterial infections, and some metastatic disease.
18. MRI SCAN
An MRI scan is more specific and sensitive than a CT
scan and should be done with and without contrast.
T1-weighted images show central isointensity. T2-
weighted images show an isotense to hypertense core
and a hyperintense rim, ring, or conglomerate of rings
with enhancement.
MRI findings may also mimic several of the
aforementioned lesions.
19. Laboratory test
Cerebrospinal Fluid. Lumbar punctures that remove
10 to 15 mL provide the best information. CSF
studies may show normal findings or have elevated
protein, decreased glucose, or pleocytosis. Results of
CSF polymerase chain reaction tests may be
diagnostic. Most patients will have an elevated
opening pressure as well.
20. Always get an AFB smear when testing CSF.
Although there are a fair amount of false negatives,
with serial AFB smears (up to 4) the diagnostic yield
is 87%.
Mantoux Tests. Mantoux tests may be positive or
negative.
Other Blood Work. Sedimentation rate, C-reactive
protein, and white blood cell count may also be
elevated.
21. Biopsy
Biopsy of the lesion should be done if the diagnosis is
unclear and the lesion is in an accessible area or if
neurologic compromise is present. Histopathology
may show a central necrosis, lymphocytes,
Langerhans giant cells, or epithelioid cells. Bacilli
may or may not be present.
No definitive diagnostic pathway is available for CNS
TB.
22. Treatment
Treatment of CNS tuberculosis is based on an anti-
tubercular treatment regimen. However, multidrug-
resistant tuberculosis remains a major hurdle in
treatment.
23. CDC guidelines recommend a 9- to 12-month
pharmacologic treatment regimen for CNS TB and
offer four regimens for administering treatment. The
initial phase of treatment in the first 2 months should
include INH, rifampin (RIF), PZA, and EMB. The
medications can be given daily throughout the first
phase, daily for 2 weeks, and then twice weekly for 6
weeks, or three times weekly throughout.
24. With differing administration schedules come
differing doses of the drugs. If the organism's drug
susceptibilities are known, and it is fully susceptible,
EMB need not be included in the initial phase.
25. PZA should be avoided in severe liver disease, gout,
and, perhaps, pregnancy. The continuation phase should
consist of INH and RIF for 7 to 10 months, and this
timeline should be prolonged if the patient was initially
slow to respond to treatment.
26. When patients with intracranial tuberculomas
experience increased intracranial pressure or neurologic
symptoms, corticosteroids can be added to the regimen,
although their value is still under investigation.
27. Surgical intervention for intracranial tuberculomas is
generally not recommended because prolonged
pharmacologic therapy combined with corticosteroids is
usually effective in treating these lesions. However,
surgery may be warranted if immediate decompression
is necessary or if biopsy is required for definitive
diagnosis.