An 8-year-old child presents with a fever of 104°F for the past 8 days. On examination, the child has mild diarrhea, abdominal distension, hepatomegaly, and splenomegaly. The likely clinical diagnosis is typhoid fever, an infectious disease caused by Salmonella enterica serovar Typhi characterized by high fever and abdominal symptoms. Typhoid fever is transmitted through contaminated food or water and has an incubation period of 7-14 days. Common clinical features include a gradual rise in fever, abdominal symptoms, and hepatosplenomegaly. Complications can include intestinal hemorrhage or perforation. Diagnosis is confirmed through blood culture but antibody tests and culture of
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Management Of Nephrotic Syndrome
Objectives
To briefly review the definition & etiology of nephroticsyndrome.
To understand the terminology pertaining to clinical course of nephroticsyndrome.
To understand the management of nephroticsyndrome:Specific management & Supportive care and management of complications
Management of congenital nephrotic syndrome
Management Of Nephrotic Syndrome
Objectives
To briefly review the definition & etiology of nephroticsyndrome.
To understand the terminology pertaining to clinical course of nephroticsyndrome.
To understand the management of nephroticsyndrome:Specific management & Supportive care and management of complications
Management of congenital nephrotic syndrome
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. Typhoid Fever
in
Children
Epidemiology, Etiology, Clinical Features, Diagnosis
Complications, Management and Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
2. (God speaking to Prophet Muhammad (PBUH)
Whatsoever is in the heavens and whatsoever is on the earth is
continuously in praise of Allah;
The King, The Noble, The Mighty and The Wise
Al Quran surah Al-Jumaa 21:1
3. Clinical Case Scenario
• An 8 year old child presents with fever for the last 8 days.
• Mother says child had gradual rise of fever
• Fever comes down with antipyretics but rises again with
chills after a few hours
• He does not have cough
• He has mild diarrhea
• On examination, his temperature is 104 F
4. Clinical Case Scenario
• On examination, his temperature is 104 F
• Skin rashes or jaundice are not present
• Respiratory rate is 25 per minute. Chest auscultation is
normal
• Throat examination are normal
• Liver and spleen are palpable by 2 cm each.
• SOMI are negative
What is the likely clinical diagnosis ?
5. Typhoid fever
An infectious disease
caused by
Salmonella enterica serovar typhi
and
characterized by
high fever and abdominal symptoms
6. Enteric Fever
• Typhoid Fever – Salmonella enterica serovar typhi
• Paratyphoid Fever – Salmonella enterica serovar
paratyphi A & B
• Typhoid and Paratyphoid fever may have similar
presentations
• Typhoid fever is more common than Paratyphoid
fevers
7. Epidemiology
• Very common in all areas of Pakistan
• Frequent in Summer season
• Can occur from infancy to old age
• Children 2 to 15 years very commonly affected
14. Clinical Features in Typhoid Fever
• First Week - Fever
- gradual (step-ladder) rise
- moderate to high (rarely low grade)
- abdominal fullness
• Second Week - Other symptoms and signs
- lethargy
- mild cough
- hepato-splenomegaly
• Third Week – Abdominal complications
- diarrhea
- intestinal hemorrhage
15. Helpful signs in Typhoid Fever
• High Fever more in evening with chills
• No focus of infection anywhere in the body
• Abdominal distension (gaseous)
• Hepatomegaly
• Splenomegaly (on deep inspiration)
• Coated tongue (non-specific)
• Relative bradycardia (in adults)
• Rose spots (rare)
16. COMPLICATIONS of Typhoid Fever
• Loss of weight
• Intestinal hemorrhage (< 5 % )
• Intestinal perforation (< 1 % )
• Typhoid encephalopathy (< 1 % )
• Relapse (after few weeks in < 5 %)
• Meningitis, osteomyelitis, cholecystitis, myocardidtis are
rare complications in immunocompromised children
18. Clinical Diagnosis
• Age 5 – 15 years
• Gradual rise of fever
• No localizing signs of focal infection
• Coated tongue
• Relative bradycardia (rare in children)
• Mild dry cough
• Abdominal distention
• Hepatomegaly
• Splenomegaly
19. INVESTIGATIONS
• For diagnosis
• CBC
• Widal test
• Typhidot test
• Blood culture
• For exclusion or DD
• USG abdomen
• X-ray Chest
• Urine Examination
• CRP
• ICT Malaria
20. How to Diagnose Infectious Diseases ?
Organism Detection (confirmatory)
• Detect the Organism - Bacterial / Viral Culture and
Sensitivity
• Find the DNA / RNA - PCR (Hepatitis C, GeneXpert for
tuberculosis, Covid 19)
• Check for Specific Antigen - ICT / ELISA (RDT for malaria,
HBsAg,)
Antibody detection (IgM recent infection, IgG past infection)
(antibody detection has variable Sensitivity and Specificity)
• Specific IgG or IgM – HBsAb, HBcIgM, Dengue IgM,
Typhidot
• Antibody assays (not reliable) - Widal test, TB Mycodot
21. DIAGNOSIS of Typhoid Fever
• CBC – Leucopenia (rarely leucocytosis), Thrombocytopenia
• Antibody tests –
- Widal test (TO titer 1:160 or more ) in 2nd week
- Typhidot test (IgM +ve ) - Specificity = 77 %
(Widal and Typhidot tests may be false-positive or false- negative)
• Salmonella typhi Culture (Gold standard)
- blood culture
- bone marrow culture
- stool culture in 2nd week
22. Blood Culture for Typhoid Fever
• Blood Culture is Gold Standard for diagnosis
• Blood culture is positive in about
90% cases in 1st week
75% cases in 2nd week
60% cases in 3rd week
• 25% thereafter till subsidence of pyrexia
• Blood cultures rapidly becomes negative on treatment
with antibiotics.
• Blood Culture also gives Sensitivity of Antibiotics
25. Symptomatic and Supportive MANAGEMENT
• Antipyretics – Paracetamol, Ibuprofen
- Tap water sponging
• Hydration – Oral / IV fluids
• Nutrition – small frequent feeds
-- Give usual diet which the child likes
-- Do not stop roti or usual food
-- No need to give soft diet if abdomen is not tender.
-- Soft diet was needed in the past when specific treatment
and antibiotics were not available
26. Antibiotics for Typhoid Fever
Choice of Antibiotic for an infection depends upon
• Severity of illness
• Route of administration - Oral or IM or IV antibiotics
• Adverse effects of antibiotics
• Antibiotic Resistance (local resistance pattern)
-- -- Inappropriate use of antibiotics promotes resistance
---- Anti-microbial resistance to bacteria is increasing
27. Antibiotics for different Types of Typhoid Fever
• Non-resistant Sensitive Typhoid
• Treated by Amoxycillin, Chloramphenicol and Co-trimoxazole
• Multi–drug resistant (MDR) typhoid - from 1990 onwards
• Salmonella typhi resistant to previously used antibiotics
• Sensitive to Ceftriaxone, Cefixime, Ciprofloxacin
• Extremely Drug Resistant (XDR) Typhoid – 2016
• Salmonella typhi resistant to all previously used antibiotics
• Resistant to Amoxycillin, Cephalosporins, Quinolones
• Sensitive to Azithromycin and Carbapenems only
28. XDR Typhoid in Pakistan - 2016
• Between Nov 30, 2016, and Dec 30, 2017, 486
people with ceftriaxone-resistant S Typhi were
identified from Hyderabad.
• The outbreak is suspected to be attributed to the
contaminated drinking water, especially the
mixing of sewage with drinking water.
• The Lancet 18(12), P1368-1376, DECEMBER 01, 2018
• Outbreak investigation of ceftriaxone-resistant Salmonella enterica serotype Typhi and
its risk factors among the general population in Hyderabad, Pakistan: a matched case-
control study
29. Specific management of Typhoid Fever
• Initial Treatment for MDR typhoid
• Ceftriaxone IV (50 – 75 mg/kg/d) for 5 -7 days
OR
• Cefixime Oral (20 mg/kg/d) for 7- 10 days
• If no response – Treatment for XDR Typhoid
• Azithromycin Oral (20 mg/kg/d) for 5-7 days
OR
• Imipenem / Meropenem IV (60 mg/kg/day)
33. Vaccination for Typhoid
• TAB vaccine (killed bacteria) - (now obsolete)
• Typhoid Vi polysaccharide vaccine
0.5 ml IM (70 % effective)
(Given at more than 2 years of age)
• Typhoid Conjugate Vaccine – TCV
0.5 ml IM ( 95 % effective)
(Given at 6 months to 45 years of age)
34. Typhoid Conjugate Vaccine - TCV
• Typhoid Conjugate Vaccine – TCV contains purified Vi
capsular polysaccharide of Salmonella typhi Ty2 which is
conjugated to Tetanus Toxoid carrier protein.
• Typhoid Conjugate Vaccine – TCV is T-cell dependent which
induces Vi antibodies that neutralize Vi antigen of Typhoid
bacillus
• Typhoid Conjugate Vaccine – TCV can be administered to
infants of age ≥6 months to ≤ 45 years, children and adults as
a single dose intramuscularly.
• Typhoid Conjugate Vaccine – TCV is being added to Expanded
Program of Immunization in Pakistan administered at 9
months of age