Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
History of Epidemics & Pandemics of World & India- A case study-peterpdPeter Prasanta Debbarma
Here one will know the cases of Epidemic and Pandemic and their nature from the World and India as well as their history and nature of spread and also safety lessons learnt
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
History of Epidemics & Pandemics of World & India- A case study-peterpdPeter Prasanta Debbarma
Here one will know the cases of Epidemic and Pandemic and their nature from the World and India as well as their history and nature of spread and also safety lessons learnt
Epidemiology & Control measures for Tuberculosis. AB Rajar
n this Lecture I tried my best to include all essential features about the TB disease. I hope that this will help to undergraduate Medical students for better understanding the Disease.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Tuberculosis
1. A 45 yr old male patient ,hailing from a
poor socioeconomic condition
came at OPD with complain of
• loss of wt &appetite
• evening rise of temp
• cough >3wks
• hemoptysis
2. TUBERCULOSIS
Tuberculosis
(abbreviated as TB for
tubercle bacillus or
Tuberculosis) is a
common and often
deadly infectious disease
caused by mycobacteria,
mainly Mycobacterium
tuberculosis.
Two type: Pulmonary &
Extrapulmonary
3. Epidemiology
According to the World Health Organization (WHO), nearly 2 billion people—one
third of the world's population—have been exposed to the tuberculosis pathogen.
Annually, 8 million people become ill with tuberculosis, and 2 million people die
from the disease worldwide.
In 2004, around 14.6 million people had active TB disease with 9 million new cases.
The annual incidence rate varies from 356 per 100,000 in Africa to 41 per 100,000
in the Americas.
Tuberculosis is the world's greatest infectious killer of women of reproductive age
and the leading cause of death among people with HIV/AIDS.
5. Epidemiology (contd..)
Major changes in trends secondary to HIV
- 1953-1985 cases decreased from 84,304 to 22,201
- during this period cases were reactivation of old
infection and elderly
- TB and AIDS registries suggests that HIV-infected
pts account for 30-50% increase in cases of TB
6. Tuberculosis prevalence rates, 2007
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
WHO 2006. All rights reserved
No report
0–24
25–49
50–99
100 or more
Notified TB cases (new and
relapse) per 100 000 population
7. AFR*
10 %
S wa z i l a nd
1%
Ni ge r i a
8 %
Ke ny a
7 %
Zi mba bwe
5 %
M oz a mbi que
5 %
Za mbi a
4 %
UR Ta nz a ni a
4 %DR Congo
4 %
Uga nda
4 %
Et hi opi a
3 %
M a l a wi
3 %
Côt e d' I v oi r e
2 %
S out h Af r i c a
19 %
Ot he r
2 1%
Brazil
AMR*
Russia
EUR*
India
SEAR*
WPR
EMR
0
5
10
15
20
Geographical distribution of
HIV-positive TB cases, 2005
For each country or region, the number of incident TB
cases arising in people with HIV is shown as a
percentage of the global total of such cases. AFR* is all
countries in the WHO African Region except those shown
separately; AMR* excludes Brazil; EUR* excludes the
Russian Federation; SEAR* excludes India.
8. WORLD TB DAY 2017: Bangladesh continues its
battle against the disease
Bangladesh has high rates of migration and the transient population
faces poverty, overcrowding and poorly ventilated living and working
conditions, all of which allow TB to spread.
The South-East Asia region accounts for a disproportionately high
number of global TB cases and Bangladesh is one of 22 ‘high TB-burden’
countries.
In 2014, there were 187,005 new cases of TB in Bangladesh and it was
the leading cause of death, accounting for 81,000 fatalities.
Ending the TB epidemic by 2030 is one of the health targets of the newly
adopted Sustainable Development Goals. WHO has set a target for a
95% reduction in deaths and a 90% reduction in TB incidence by 2035.
As World Tuberculosis Day(24th March) marks renewed efforts to ‘Unite to
end TB’, we give some insight into the disease that remains a major
public health problem for Bangladesh.
9. Incidence
1985-1990 TB cases increased 55% in Hispanics and
27% in African Americans
Populations at risk
- Foreign-born individuals
- Low socioeconomic status
- Cancer pts
- Celiac disease
- Cigarette smokers
- TNF-a antagonists
- Corticosteroids
- HIV
10. Case Definations…
Smear positive TB : At least 2 sputum smear positive for AFB
initially
or
1 smear positive and 1 positive culture
or
1 smear positive and radiographic abnormality with active
pulmonary TB
Smear negative TB : At least three negative smears but TB
suggestive symptoms and X-ray abnormality or positive
culture
11. Case Definations (contd…)
Relapse : A pt who returns smear positive having previously
been treated for TB and declared cured after the completion
of his treatment
Failure case : A pt who was initially smear positive , who
began treatment but remained or became smear positive
again at five months or later during the course of treatment
12. Case Definations (contd…)
MDR TB : It is a specific form of drug-resistant TB due to a
bacillus resistant to at least isoniazid and rifampicin, the two
most powerful anti-TB drugs
XDR-TB : It is resistance to at least Isoniazid and Rifampicin
(i.e. multidrug-resistant TB or MDR-TB), plus resistance to any
fluroquinolones, and any one of the second-line anti-TB
injectable drugs (Amikacin, Kanamycin or Capreomycin).
13. Transmission
When people suffering from active pulmonary TB cough,
sneeze, speak, or spit, they expel infectious aerosol droplets
0.5 to 5 µm in diameter.
A single sneeze can release up to 40,000 droplets.
People with prolonged, frequent, or intense contact are at
particularly high risk of becoming infected, with an estimated
22% infection rate.
A person with active but untreated tuberculosis can infect
10–15 other people per year.
Others at risk include people in areas where TB is common.
15. Transmission
residents and employees of high-risk congregate settings,
medically under-served and low-income populations,
high-risk racial or ethnic minority populations,
children exposed to adults in high-risk categories,
patients immunocompromised by conditions such as
HIV/AIDS, people who take immunosuppressant drugs,
and health care workers serving these high-risk clients.
18. M tuberculosis
Aerobic, non-sporing, non-capsulated, non-motile rod
On artificial media, coccoid & filamentous forms are seen with
variable morphology from one species to other
1.2-4 μm (1-10) x 0.3-0.5 μm
Arranged singly, in pairs or in clumps
Cell wall contains abundance of complex lipids, some of which are
unique to mycobacteria
Requires special media for growth.They are
L-J Media(6 wk)
MiddleBrook agar Media
BACTEC(1-3 wk)
MGIT
20. Pathogenesis
Reservoir: human with active tuberculosis
Primary cells infected: macrophage
Bacilli after entry into body reside principally
intracellularly inside
• monocytes,
• RE cells
• giant cells.
21. TB Pathogenesis (1)
Latent TB Infection
Once inhaled, bacteria travel to lung alveoli and establish
infection
2–12 wks after infection, immune response limits activity;
infection is detectable
Some bacteria survive and remain dormant but viable for
years (latent TB infection, or LTBI)
22. TB Pathogenesis (2)
Latent TB Infection
Persons with LTBI are
Asymptomatic
Not infectious
LTBI formerly diagnosed only with TST
Now QFT-G can be used
23. Pathology
Production & development of lesions & their healing or
progression are determined chiefly by-
a. number of bacilli in the inoculum & their
subsequent multiplication &
b. resistance & hypersensitivty of the host
Two principal types of lesions- exudative & productive
type
24. Exudative lesion
Acute inflammatory reaction, with edema fluid, PMNs, &
later monocytes around tubercle bacilli
Seen particularly in lung tissue
Fate-
a. may heal by resolution
b. may lead to massive necrosis of tissue
c. may develop into productive type of lesion
During exudative phase- tuberculin test become positive
25. Productive lesion
Fully developed lesion- granuloma formation
Granuloma- 3 zones- tubercle
a. central area of large, multinucleated giant cells
containing tubercle bacilli
b. midzone of pale epithelioid cells
c. peripheral zone of fibroblasts, lymphocytes &
monocytes
Later central area undergoes caseation & peripheral fibrosis
Fate-
a. caseous tubercle may break into bronchus & empty
its contents there – form a cavity
b. heal by fibrosis or calcification
26. Upper two: granuloma with central caseation necrosis
Lower left: granuloma without caseation
Lower right: non-reactive TB (no granuloma)- sheets of foamy
histiocytes packed with mycobacteria
27. Spread of organism in the host
Direct extension
Lymphatic spread
Hematogenous spread
Spread by natural passages
28. Types of infection
Primary & secondary (reactivation) tuberculosis:
Primary tuberculosis: develops in previously unexposed &
therefore unsensitized person – first contract with tubercle
bacilli
Source of organism- exogenous
Acute exudative lesions rapidly spreading to lymphatics &
regional lymph nodes (hilar)
Heals rapidly or may disseminate
Lymph nodes- massive caseation that usually calcifies
Common site- base of the lung
Other organs involved- intestine, cervical lymph nodes,
meninges, bones & joints, skin etc
29. Types of infection (contd..)
Ghon’s focus: primary local lesion
Primary (Ghon) complex: Ghon’s focus, strands of
affected lymphatics & enlarged lymph nodes (hilar)
About 5% primary infection- leads to disease
Lymphohematogenous dissemination- dreaded
complication → tuberculous meningitis & disseminated
(miliary) tuberculosis
Usually occurred in childhood or in tuberculin-negative
adults
Tuberculin test become positive in 2-4 weeks after
infection
34. Diagnosis of TB
Specimens required
Pulmonary
• Sputum* (induced with nebulised hypertonic saline if not
expectorating)
• Bronchoscopy with washings or BAL
• Gastric washing* (mainly used for children)
Extrapulmonary
• Fluid examination (cerebrospinal, ascitic, pleural,
pericardial,joint): yield classically very low
• Tissue biopsy (from affected site): bone marrow/liver may be
diagnostic in disseminated disease
35. Diagnostic tests
Tuberculin skin test: low sensitivity/specificity; useful only in
primary or deep-seated infection
Stain
Ziehl–Neelsen
Auramine fluorescence
Nucleic acid amplification
Culture
Solid media (Löwenstein–Jensen, Middlebrook)
Liquid media (e.g. BACTEC or MGIT)
Pleural fluid: adenosine deaminase
Response to empirical antituberculous drugs (usually seen
after 5–10 days)
37. Mantoux Tuberculin Skin Test
Preferred method of skin testing for M. tuberculosis infection
TST is useful for
Determining how many people in a
group are infected (e.g., contact
investigation)
Examining persons who have
symptoms of TB
Multiple puncture tests (e.g., Tine Test) are inaccurate and not
recommended
38. Administering the TST
Inject 0.1 ml of 5 TU PPD
tuberculin solution
intradermally on volar
surface of forearm using
a 27-gauge needle
Observed for 30 min for
any immediate type of
reactions
Produce a wheal 6 to 10
mm in diameter in 48-72
hrs
39. Reading & interpretation
Final reading after 72 hrs (48-72 hrs)
Positive reaction : area of induration 10 mm or
more – persists for several days- indicates person
has an infection & continue to carry viable
mycobacteria
Negative reaction: no area of induration
Doubtful reaction: <10 mm
In HIV positive cases: ≥5 mm induration is
positive
Induration >15 mm: indicative of active
tuberculosis
Tuberculin negative- susceptible to tubercular
infection
40. Factors That May Cause False-Positive
TST Reactions
Nontuberculous mycobacteria
Reactions caused by nontuberculous
mycobacteria are usually 10 mm of
induration
BCG vaccination
Reactivity in BCG vaccine recipients
generally wanes over time; positive TST
result is likely due to TB infection if risk
factors are present
41. False negative tuberculin reaction
Overwhelming tuberculous infection with marked
toxaemia (disseminated or miliary tuberculosis)
Newborn & elderly
Recent viral infection (e.g measles or infectious
mononucleosis) or vaccination
Immunosuppression like AIDS
Malnutrition
Immunosuppressive therapy
Malignancy- Hodgkin’s disease
Sarcoidosis
Scarlet fever
42. Factors That May Cause False-Negative
TST Reactions (1)
Anergy
Inability to react to a TST because of a
weakened immune system
Usefulness of anergy testing in TST-
negative persons who are HIV infected
has not been demonstrated
43. Factors That May Cause False-Negative
TST Reactions (2)
Recent TB infection
Defined as 2 to 10 weeks after exposure
Very young age
Newborns
44. Factors That May Cause False-Negative
TST Reactions (3)
Live-virus vaccination
For example, measles or smallpox
Can temporarily suppress TST reactivity
Overwhelming TB disease
Poor TST administration technique
For example, TST injection too shallow
or too deep, or wheal is too small
45. ADA
Adenosine DeAminase is an enzyme.
ADA positive means serum ADA>14U/L
Sensitivity : 92.7%
Specificity : 88.1%
Advantages :
1. Quick . eg culture is lengthy
2. Accurate diagnosis.eg AFB may absent in that specific sample
3. Helps in Monitoring
4. No requirement of expertise.eg PCR require expert person.
47. Tuberculosis treatment
The standard "short" course treatment for tuberculosis (TB), is
isoniazid, rifampicin, pyrazinamide, and ethambutol for two months,
then isoniazid and rifampicin alone for a further four months. The
patient is considered cured at six months (although there is still a
relapse rate of 2 to 3%). For latent tuberculosis, the standard treatment
is six to nine months of isoniazid alone.
If the organism is known to be fully sensitive, then treatment is with
isoniazid, rifampicin, and pyrazinamide for two months, followed by
isoniazid and rifampicin for four months. Ethambutol need not be
used.
48. Drugs (contd..)
All first-line anti-tuberculous drug names have a
standard three-letter and a single-letter abbreviation:
1. ethambutol is EMB or E,
2. isoniazid is INH or H,
3. pyrazinamide is PZA or Z,
4. rifampicin is RMP or R,
5. Streptomycin is STM or S.
49. Drugs (contd..)
There are six classes of second-line drugs (SLDs) used for the
treatment of TB. A drug may be classed as second-line
instead of first-line for one of two possible reasons: it may be
less effective than the first-line drugs.
1. aminoglycosides: e.g., amikacin (AMK), kanamycin (KM);
2. polypeptides: e.g., capreomycin, viomycin, enviomycin;
3. fluoroquinolones: e.g., ciprofloxacin (CIP), levofloxacin,
moxifloxacin (MXF);
4. thioamides: e.g. ethionamide, prothionamide
5. cycloserine (the only antibiotic in its class);
6. p-aminosalicylic acid (PAS or P).
50. Drugs
considered "third-line drugs"
not very effective or because their efficacy has not been proven .
Rifabutin is effective, but is not included on the WHO list because
for most developing countries, it is impractically expensive.
1. rifabutin
2. macrolides: e.g., clarithromycin (CLR);
3. linezolid (LZD);
4. thioacetazone (T);
5. thioridazinea;
6. arginine;
7. vitamin D;
8. R207910.
53. Adjunctive Treatment
Pyridoxine (Vitamin B6)
The use of Pyridoxine is recommended for all adults patients started on TB treatment
to prevent peripheral neuropathy most commonly caused by Isoniazid.
Dose of Pyridoxine: 25mg daily
If patient develops peripheral neuropathy at any stage during TB treatment, the dose
can be increased to 50 – 75mg (up to maximum of 200mg) until the symptoms
subside, then reduce to 25mg daily.
Steroids
The use of corticosteroids is recommended in extra-pulmonary tuberculosis,
particularly for TB meningitis and pericarditis. High dose steroid treatment for 2-4
weeks and the taper off gradually over several weeks depending on clinical progress is
recommended.
The response to treatment is assessed clinically.
54. Counselling of Patient
Medication that the patient will be taking, when and how to take it, the side effects
they may experience from the medication and what to do when the side effects
develop.
The duration of treatment; important milestones during treatment such as sputum
testing to monitor the response to treatment and changes in medication; the
importance of completing treatment
Expected benefits of adherence
Expected consequences of non-adherence
Developing an adherence plan to identify barriers to treatment and address these
to ensure treatment completion
The link to HIV and the need for an HIV test
General health issues including how to eat a balanced diet using readily available
food, exercising, stopping smoking and reducing alcohol intake.
55. Monitoring and DOTS
DOTS stands for "Directly Observed Therapy, Short-course" and is
a major plan in the WHO global TB eradication programme.
The DOTS strategy focuses on five main points of action.
1. These include government commitment to control TB,
2. diagnosis based on sputum-smear microscopy tests done on patients who
actively report TB symptoms,
3. direct observation short-course chemotherapy treatments,
4. a definite supply of drugs, and
5. standardized reporting and recording of cases and treatment outcomes.
56. Prevention
TB prevention and control takes two parallel
approaches.
In the first, people with TB and their contacts are
identified and then treated.
Identification of infections often involves testing
high-risk groups for TB.
In the second approach, children are vaccinated to
protect them from TB.
57. Vaccines
Many countries use Bacillus Calmette-Guérin (BCG) vaccine
as part of their TB control programs, especially for infants.
According to the W.H.O., this is the most often used vaccine
worldwide, with 85% of infants in 172 countries immunized in
1993.
BCG provides some protection against severe forms of
pediatric TB
unreliable against adult pulmonary TB,
Currently, there are more cases of TB on the planet than at
any other time in history
urgent need for a newer, more effective vaccine that would
prevent all forms of TB—including drug resistant strains—in
all age groups and among people with HIV.