1. Urinary tract infections (UTIs) are common in children and can lead to serious complications if not properly treated.
2. A urine culture is needed to confirm the diagnosis, though collection can be challenging in young children. Imaging studies may also be used to identify structural abnormalities.
3. For most children with UTIs, oral antibiotics are used. However, more serious infections may require hospitalization and intravenous antibiotics. Long-term management focuses on preventing recurrences through modifications to diet, hygiene and other risk factors.
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
Description of Urinary tract infections of pediatric age group, signs and symptoms, presentations, diagnosis, investigations, prognosis and management plan
Pancreatitis is an inflammatory condition of the pancreas. Two major forms : acute pancreatitis (is reversible) and chronic pancreatitis(is irreversible).
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
Pancreatitis is an inflammatory condition of the pancreas. Two major forms : acute pancreatitis (is reversible) and chronic pancreatitis(is irreversible).
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
This presentation covers Urinary tract Infections (UTI). Their Definition, forms, epidemiology, risk factors, etiology, Clinical manifestation, Diagnostic procedures, Management, Complications and Education to the Patients are discussed in detail.
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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.
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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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
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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.
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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
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Are There Any Natural Remedies To Treat Syphilis.pdf
Urinary tract infection
1. THE CHILD WITH URINARY TRACT
INFECTION
Presented by
Dr. Sushan Ekanayake
2. References
• Nelson Textbook of Paediatrics – 1st South Asia Edition
• National Guidelines for Managing UTI in Children
• NICE Guidelines – 2018
• The child with urinary tract infection : a dilemma for the
paediatrician – Prof. Chandra Abeysekera
• Revised AAP Guidelines
3. This is about…
• Impact
• Definitions and Terminology
• Prevalence
• Aetiology
• Risk Factors
• Clinical Presentation
• Approach to the patient
History, Examination, Investigations
• Management
• Prevention
• Information and Advice
• VUR
4. Impact of childhood UTI
• 2-3% of hospital admissions
• 4-7% of febrile illnesses in childhood
• Frequently misdiagnosed and mismanaged
• structural abnormalities that may predispose them to
recurrent infections and kidney damage.
5. Improper investigations / treatment will lead to…
– Continuing/recurrent infection
– Gross renal scarring
– Hypertension/chronic renal failure
Prevention or delaying the progression of ESRF is more
important than RRT
6. Definition
Infection of the urinary tract is identified by the growth of a significant
number of organisms of a single species in a properly collected sample
of urine, in the presence of symptoms
7. Prevalence
• 1% of boys, 1-3% of girls
• Varys with age
– 1st year of life M:F – 2.8-5.4:1
– Beyond 1-2 years M:F – 1:10
• 1st UTI
– Boys – 1st year
– Girls – 5 years of age
13. Atypical UTI:
• seriously ill
• poor urine flow
• abdominal or bladder mass
• raised creatinine
• septicaemia
• failure to respond to treatment with suitable antibiotics within 48 hours
• infection with non-E. coli organisms.
Recurrent UTI:
• two or more episodes of UTI with acute pyelonephritis/upper urinary tract
infection
• one episode of UTI with acute pyelonephritis/upper urinary tract infection
plus one or more episode of UTI with cystitis/lower urinary tract infection
• three or more episodes of UTI with cystitis/lower urinary tract infection.
15. History and Examination
History
• Dysuria, straining, increased frequency, incontinence, poor urine flow
• Secondary enuresis
• Macroscopic hematuria or pyuria
• Unexplained lower abdominal pain, flank pain
• Infant and young child with unexplained fever (>38.50C) for more than three days or
persistent vomiting or irritability
• History suggesting previous UTI or confirmed previous UTI
• Recurrent fever of uncertain origin
• Antenatally diagnosed renal abnormality
• Family history of vesicoureteric reflux (VUR) or renal disease
• Constipation
* Exclude UTI in all neonates with septicaemia and prolonged jaundice
16. Examination
• Fever / Dehydration / General ill health
• Elevated blood pressure
• Palpable bladder (after voiding) – Can be due to acute retention. May
also be due to a neurogenic bladder or posterior urethral valves (PUV)
in a male child.
• Ballotable kidneys / Renal angle tenderness
• Spinal defects
• External genitalia:
- Labial adhesions
- Phimosis (fore skin is usually not retractable < 4 yrs)
- Signs of inflammation
17.
18. NICE Recommendation
• Infants and children presenting with unexplained fever of
38oC or more should have a urine sample tested after 24H at
the latest
• Infants and children with symptoms and signs suggestive of
UTI should have a urine sample tested for infection
20. Why <2y ?
Diagnosis and management of UTI in this group is
challenging
– No localizing signs – delay in diagnosis of UTI
– Collection of clean urine samples is difficult
– Delay in therapy – increases the risk of renal damage
– Increased incidence of underlying abnormalities
– 25% - 50% have underlying vesico-ureteic reflux
21. Investigations
• Urinalysis - supportive
• Urine for culture / ABST – Positive urine culture is the gold
standard of diagnosis
– Its validity depends on the proper collection
– A clean catch urine sample is the recommended method for urine
collection. If a clean catch urine sample is unobtainable, non-invasive
methods such as urine collection pads can be used.
– When it is not possible or not practical to collect urine by non-invasive
methods, catheter samples or supra-pubic aspiration (SPA) should be
used.
22. Sample Collection - Methods
Infant or young child who is not potty trained
1. Clean catch mid stream sample (CCMS)
2. Supra pubic aspiration (SPA)
3. Catheter samples (only in failed attempts of SPA)
Older child
1. CCMS
2. SPA (in special situations)
23. Advice to parents on collection of CCMS urine
sample
• Wash hands and genitalia with water - No antiseptics (Retract
the prepuce of the older boys)
• Do not wash the urine culture bottle and do not leave the lid
opened for a long time
• Send first few mLs of urine out and collect a mid stream
specimen directly into the sterile culture bottle without
contamination
• Close the cap and hand over immediately
24. Sample Transportation
• Method and time of collection must be stated in the request
form
• Send immediately to the lab
• If the specimen cannot be transported within 2 hours,
refrigerate immediately at 40C – maximum time of
refrigeration is 24 hours
26. Role of imaging studies
• Ultrasound Scan
• DMSA Scan (Dimercaptosuccinic Acid Scan)
• MCUG (Micturation Cysto-Urethrogram)
27.
28.
29.
30.
31. Other imaging studies
–DTPA scan (Diethylene Triamine Pentaacetic Acid)
• Suspected pelvi-ureteric or vesico-ureteric junction obstruction
–X-Ray KUB
• UTI associated with persistent or recurrent microscopic or
macroscopic haematuria
35. Management of Acute Phase
• Correct dehydration
• Control pain and fever (Liberal fluid intake reduces dysuria)
• persistent vomiting Domperidone may be useful
36. • Admission criteria
1. Neonates and young infant
2. Ill, toxic and dehydrated child
3. Persistent vomiting
4. Symptoms and / or signs suggestive of obstruction or calculi
37. Acute Management :NICE Recommendation
• Infants and children with a high risk of serious illness
should be referred urgently to the care of a pediatric
specialist.
• Infants younger than 3 months with a possible UTI
should be referred immediately to the care of a
pediatric specialist.
• Treatment should be with parenteral antibiotics
38. • For infants and children 3 months or older with acute
pyelonephritis/upper urinary tract infection:
–Consider referral to secondary care.
–Treat with oral antibiotics for 7–10 days. Use an oral
antibiotic with low resistance patterns. Ex: cephalosporin
or co-amoxiclav.
–If oral antibiotics cannot be used, treat with an intravenous
(IV) antibiotic agent such as cefotaxime or ceftriaxone for
2–4 days followed by oral antibiotics for a total duration of
10 days.
39. For infants and children 3 months or older with cystitis/lower urinary
tract infection:
• Treat with oral antibiotics for 3 days. The choice of antibiotics should
be directed by locally developed multidisciplinary guidance.
Trimethoprim, nitrofurantoin, cephalosporin or amoxicillin may be
suitable.
• Infant or child has to be reassessed, if still unwell after 24–48 hours.
If an alternative diagnosis is not made, a urine sample should be
sent for culture to identify the presence of bacteria and determine
antibiotic sensitivity if urine culture has not already been carried
out
40. • For infants and children who receive aminoglycosides (gentamicin or
amikacin), once-daily dosing is recommended.
• If parenteral treatment is required and IV treatment is not possible,
intramuscular treatment should be considered.
• If an infant or child is receiving prophylactic medication and develops
an infection, treatment should be with a different antibiotic, not a
higher dose of the same antibiotic.
• Asymptomatic bacteriuria in infants and children should not be
treated with antibiotics.
• Laboratories should monitor resistance patterns of urinary pathogens
and make this information routinely available to prescribers
41. Antibiotics
• A valid urine sample must be obtained before antibiotic therapy and
this may warrant a SPA for infants and young children.
• Prompt treatment with the best guess antibiotic in appropriate
dosage must be started in all suspected cases of febrile UTI pending
the urine culture result and the drug can be changed according to the
ABST pattern later.
• Treatment can be delayed till urine culture report is available if the
child is afebrile and not ill.
42.
43. Long term management : NICE Recommendation
Aim is to prevent recurrence
Risk factors for recurrence
• Infants younger than 6 months at the time of the first UTI, family history of UTI,
dilating VUR, infrequent voiding, poor fluid intake and functional stool retention may
be associated with an increased risk of recurrent UTI, but evidence is limited.
• Infrequent voiding, poor fluid intake, functional stool retention, inadequate genital
hygiene, dysfunctional voiding and bladder over-activity may coexist.
• Renal scarring : Recurrent UTI was significantly associated with renal parenchymal
defects seen on first UTI
44. Dysfunctional elimination syndromes and constipation
should be addressed in infants and children who have
had a UTI.
Children who have had a UTI should be encouraged to
drink an adequate amount, should have ready access to
clean toilets when required and should not be expected
to delay voiding.
45. Antibiotic Prophylaxis
Antibiotic prophylaxis aims to reduce the risk of recurrent,
symptomatic UTIs and the subsequent development of
pyelonephritic scarring characterised on imaging as renal
parenchymal defects.
• Antibiotic prophylaxis should not be routinely recommended in infants and
children following first-time UTI. (NICE)
• Antibiotic prophylaxis may be considered in infants and children with recurrent
UTI.
• Asymptomatic bacteriuria in infants and children should not be treated with
prophylactic antibiotics.
46. • Antibiotic prophylaxis is indicated for all children below 5 years following
the first attack of UTI until an USS of the kidneys is available.
• Drugs are given as a single dose in the night
• Continuation of prophylaxis is decided according to following factors.
First attack <1 year
a) If the USS is normal in infants with afebrile UTI, it is recommended to stop
the prophylaxis and to follow up without further investigations.
b) In infants with febrile UTI, it is continued till recommended imaging studies
are available or until their first birthday; whichever comes last.
c) Those with structural abnormalities or recurrent UTI need prophylaxis till 5
years or longer.
47. First attack between 1-5 years
a) Those children with normal USS following an afebrile or a
simple febrile UTI will be followed up without prophylaxis or
further investigations.
b) Those with structural abnormalities or recurrent UTI need
prophylaxis till 5 years or longer.
50. Management of recurrent attacks of UTI
• Confirm the diagnosis, and obtain a urine sample via a SPA for
repeat culture, in children not potty trained.
• Treat promptly with an appropriate antibiotic pending the culture
report.
• Identify correctable risk factors e.g.: constipation, poor hygiene,
inappropriate voiding practices etc.
• Treat phimosis or labial adhesions appropriately. (They lead to
false positive culture reports)
• Imaging studies as indicated.
• Check the compliance, especially if the urine culture yields
organisms sensitive to the prophylactic antibiotic used.
51. Evidence based recommendations
• Ballooning of prepuce does not indicate phimosis. if the urine stream
is good circumcision is not necessary
• Afebrile symptomatic UTI indicate lower UTI or cystitis. No urgency to
commence treatment. Advanced imaging not necessary
• Asymptomatic positive cultures require no treatment. Most commonly
due to local colonization
52. Follow Up
• Infants and children who do not undergo imaging
investigations should not routinely be followed up.
• When results are normal, a follow-up outpatient
appointment is not routinely required.
• Infants and children who have recurrent UTI or abnormal
imaging results should be assessed by a pediatric specialist.
• Assessment of infants and children with renal parenchymal
defects should include height, weight, blood pressure and
routine testing for proteinuria.
53. • Infants and children with a minor, unilateral renal parenchymal
defect do not need long-term follow-up unless they have
recurrent UTI or family history or lifestyle risk factors for
hypertension.
• Infants and children who have bilateral renal abnormalities,
impaired kidney function, raised blood pressure and/or
proteinuria should receive monitoring and appropriate
management by a paediatric nephrologist to slow the progression
of chronic kidney disease.
• Infants and children who are asymptomatic following an episode
of UTI should not routinely have their urine re-tested for
infection.
• Asymptomatic bacteriuria is not an indication for follow-up.
55. • VUR can be a risk factor for recurrent UTI. With bladder growth and
maturation there is a tendency for reflux to resolve or improve.
• Management of VUR:
– Prophylaxis is recommended for VUR till 5 years of age. Longer regimes are indicated for
recurrent UTI.
– Advice on double micturition.
– Recurrent attacks of UTI need prompt treatment.
– A repeat DMSA scan to assess new scar formation might be recommended in case of repeat
attacks of febrile UTI
– Repeat MCUG to assess the improvement of reflux is not usually recommended unless there is
a plan for surgery.
When micturating cystourethrogram (MCUG) is performed,
prophylactic antibiotics should be given orally for 3 days with MCUG
taking place on the second day. (NICE Guidelines)
56. • There is no world wide consensus regarding the indications for surgical
intervention in VUR. Each patient with reflux has to be assessed
individually.
• Definite indications for surgical intervention
– Recurrent break through infections
• Relative indications for surgical intervention
– Poor compliance for prophylaxis
– Recurrent infections in spite of prophylaxis.
– New scar formation
– Impaired renal function
– Persistent gross VUR (Grade IV - V) or persistent moderate VUR (grade III) with
recurrent infections after discontinuation of prophylaxis
57. Information and Advice
Healthcare professionals should offer children and young people
and/or their parents or carers appropriate advice and information
on:
• prompt recognition of symptoms
• urine collection, storage and testing
• appropriate treatment options and prevention of further attacks
• continuation of prophylactic treatment and avoiding predisposing
factors
• double micturition in patients with VUR
58. Simple measures to practice for prevention
• Avoid constipation
• Increase fluids
• Cleanliness
• Regular bladder emptying
• Attention to underwear
59. Take home message
UTI is a common bacterial infection in children. It may be difficult to
recognize UTI in children because the presenting signs and symptoms
are non specific, particularly in younger children. Urine collection and
interpretation of urine tests in children are not easy and therefore it may
not always be possible to unequivocally confirm the diagnosis
So the primary care clinician has a major role in this initial management,
which involves early and accurate diagnosis, prompt treatment and
appropriate referral for further evaluation.