This document provides an overview of urinary tract infections (UTIs). It discusses the terminology, classification, epidemiology, etiology, pathogenesis, risk factors, clinical presentation, diagnosis, and treatment of UTIs. UTIs can affect different parts of the urinary tract and are classified as uncomplicated or complicated depending on underlying conditions. Escherichia coli is the most common cause. Diagnosis involves urinalysis, urine culture, and imaging tests. Treatment depends on the site and severity of infection, and commonly involves short courses of antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones.
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.
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.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Pyelonephritis
It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.
Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Pyelonephritis
It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.
Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance.
First Urinary Tract Infection Episode in Children: Are Procalcitonin Values & US Examination of Importance in the Diagnosis of Upper Urinary Tract Infection ?
Urinary tract infection (UTI) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Urinary Tract Infection (Pyelonephritis, Cystitis). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Symptomatic presence of micro-organisms within the urinary tract i.e., kidney, ureters, bladder and urethra.
• Associated with inflammation of urinary tract.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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!
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
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
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.
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.
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
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.
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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
4. Introduction
• Symptomatic
presence of micro
organisms within the
urinary tract
i.e., kidney, ureters,
bladder and urethra.
• Associated with
inflammation of
urinary tract.
5. • Significant bacteriuria: presence of at least
105 bacteria/ml of urine.
• Asymptomatic bacteriuria : bacteriuria with
no
symptoms.
• Urethritis: infection of anterior urethral tract
*dysuria, urgency and frequency of urination.
• Cystitis: infection to urinary bladder
*dysuria, frequency and urgency, pyuria and
6. • Acute pyelonephritis: infection of
one/both kidneys; sometimes lower tract
also.
*pyuria, fever, painful micturition
• Chronic pyelonephritis: particular type of
pathology of kidney; may/may not be
due to infection.
7. UTI - Terminology
• Uncomplicated: UTI without underlying renal or
neurologic disease.
• Complicated: UTI with underlying structural,
medical or neurologic disease.
• Recurrent : > 3 symptomatic UTIs within 12
months following clinical therapy.
• Reinfection: recurrent UTI caused by a different
pathogen at any time
• Relapse: recurrent UTI caused by same species
causing original UTI within 2 wks after therapy.
8. UTI
Upper Lower
•Acute pyleonephritis •Cystitis
•Chronic pyleonephriitis •Prostatitis
•Interstitial pyleonephritis •Urethritis
•Renal abscess
•Perirenal abscess
•Both upper & lower UTI are further divided into
complicated and uncomplicated.
9. Epidemiology
Seen in all age groups
Infants up to 6 months – 2/1000
More common in boys than girls
Women – at greater risk than men; prevalence
40-50% in women and 0.04% in men.
10% women have recurrent UTI in their life
7 million new cases of lower UTI / year
1 million hospitalizations / year
Incidence of UTI increases in old age; 10% of
men and 20% of women are infected.
10. Etiology
• Acute uncomplicated UTI:
• Escherichia coli – cause about 80% of UTI
• 20% of UTI caused by-
Gram negative enteric bacteria – Klebsiella,
Proteus
Gram positive cocci – Streptococcus
faecalis
Staphylococcus saprophyticus
• S.saprophyticus – restricted to infections in
young sexually active women.
11. Complicated UTI:
Pseudomonas aeruginosa, Enterobacter &
Serratia
Isolated in hospital acquired infections and
catheter associated UTI.
Viruses - Rubella, Mumps and HIV
Fungi - Candida, Histoplasma capsulatum
Protozoa - T. vaginalis, S. haematobium
12. Pathogenesis
• 4 routes of bacterial entry to urinary
tract.
1) Ascending infection
2) Blood borne spread
3) Lymphatogenous spread
4) Direct extension from other organs
13. • Ascending Infection:
most common route.
organisms ascend through urethra into
bladder.
organism
Colonize in
perineal and
periurethral areas
Ascend to
bladder,
kidneys
UTI
14. • Hematogenous
spread:
Blood borne
spread to kidneys.
Occurs in
bacteraemia
mostly S.aureus.
15. • Lymphatogenous spread:
Men- through rectal and colonic
lymphatic vessels to prostrate and
bladder.
Women- through periuterine lymphatics
to urinary tract.
• Direct extension from other organs:
Pelvic inflammatory diseases
Genito-urinary tract fistulas
16. • The organism:
E.coli – many strains present but only few
cause infection.
Virulence factors:
1. fimbriae
2. resistance to serum bactericidal activity
; increased amounts of capsular K antigen
activity
3. toxin production
4. production of urease enzyme (proteus
sps)
23. • Pyleonephritis:
Invasive nature
Suprapubic
tenderness
Fever and chills
White blood cell casts
in urine
Back pain
Nausea and vomiting
Complications include sepsis, septic shock
and death.
24. Clinical manifestations depending on age
• Babies and infants:
Failure to thrive
Fever
Apathy
Diarrhoea
• Children:
Dysuria, urgency, frequency
Haematuria
Acute abdominal pain
Vomiting
25. • Adults:
Lower UTI- frequency, urgency,
dysuria,
haematuria
Upper UTI- fever, rigor and lion pain
and symptoms of lower UTI.
• Elderly patients:
Mostly asymptomatic
Not diagnostic as the symptoms are
common with age.
33. UTI
urinalysis
Urine microscopy and culture
Further investigation
pyelonephriti
Adult female Male s Children
Lower UTI Any UTI Complicated Any UTI
Treat without Blood
further Ultrasound cultures cystourethro
investigation cystoscopy CT scan graphy
Check renal
34. UTI - management
• Symptomatic UTI- antibiotic therapy
• Asymptomatic UTI- no treatment required
except in special situations.
• Non- specific therapy:
• more water intake.
• Maintaining acidity of urine by fluids like
canberry juice.
35. Anti-microbial therapy
• Goals of therapy:
Elimination of infection
Relief of acute symptoms
Prevention of recurrence and long
term complications
• Decision to hospitalize ??
• Treatment considerations ??
36. • Ideal antibiotic for UTI :
Adequate coverage over E.coli
Concentration in urine
Duration of therapy
Low resistance
Cost
Low adverse effect profile
37. Principles of anti microbial therapy
• Levels of antibiotic in urine but not in
blood
• Blood levels of antibiotic – important in
pyleonephritis
• Penicillins and cephalosporins – drugs of
choice for UTI with renal failure.
39. Single dose therapy
a. Trimethoprim- sulfamethaxole
bactrim–DS : TMP–160mg + SMZ–800mg
co-trimoxazole-DS :TMP-160mg + SMZ-800mg
b. Amoxicillin- clavulnate 500mg
aceclav tab
acmox- AG tab
c. Amoxcillin 3gm
d. Ciprofloxacin 500mg – alquin tab
e. Norfloxacin 400mg – Actiflox-400 tab
40. • for uncomplicated UTI
• Not for patients with
1. past history of complicated UTI
2. history of antibiotic resistance
3. history of relapse with single dose
• advantages: compliance, cost, less side
effects, less resistance
• Disadvantages: increased recurrence or
relapse
41. 3 day therapy
• Efficacy same as 7 day therapy with less
adverse effects
• Drugs used include
1. quinolines
2. TMP-SMZ
3. betalactam antibiotics
• Extended release ciprofloxacin
500mg for uncomplicated UTI
1000mg for complicated UTI
42. 7 day therapy
• Used less for uncomplicated UTI
• Useful in 1. recurrent cases
2. pregnancy
3. UTI with other risk factors
14 day therapy
• For complicated UTI
• High risk of mortality and morbidity
47. Asymptomatic bacteriuria
• Children – treatment same as
symptomatic bacteriuria
• Adults –
treatment required in cases of
a. pregnancy
b. patient with obstructive structural
abnormalities
48. Bacteriuria in pregnancy
• To prevent risk of pyelonephritis
• 7 day course with following antibiotics
Cephalaxin
Nitrofurantoin
Amoxicillin
• Therapy continued at regular intervals
of pregnancy.
49. Relapsing UTI
• 7-10 day course
• If fails – 2week course / 6week course
• Structural abnormalities corrected by
surgery
• 6week course –
a. children
b. adults with continuous symptoms
c. high risk of renal damage
50. Prophylaxis for UTI
• Single dose of trimethoprim 100mg /
nitrofurantion 50mg
• Long term low dose prophylaxis
beneficial
• Women- single dose of antibiotic after
sexual intercourse.
51. Catheter associated UTI
• Asymptomatic UTI develop in
catheterized patients after 10-14 days.
• Antibiotic treatment - eradicate
organism but high chance of relapse.
• Catheter removal before treatment is
beneficial.
53. Sulfamethoxazole-trimethoprim
Adverse effects: Mechanism of action
o Steven Johnson's syndrome
o Dermatitis
o Angiodema
o GI disturbances
o Agranulocytosis
Contraindicated in
o Hypersensitivity to sulfa
drugs
o Infants
o Megaloblastic anaemia
54. nitrofurantoin
Damages bacterial DNA.
Reduced to reactive forms by bacterial
nitroreductase- damage DNA, ribosomes
Adverse effects:
o Hypersensitivity pneumonitis,GI
disturbances, haemolytic anaemia
Contraindications:
o Renal failure, neonates, pregnancy
55. Cefixime
3rd generation cephalosporin
Disrupts synthesis of peptidoglycan of
bacterial cell wall
Adverse effects:
o Rash, utricaria
o Diarrhea
o Thrombocytopenia
o leucopenia
56. Amoxicillin
Penicillin class antibiotic
Inhibits cross linking of peptidoglycan
polymer chains which is the major
component of bacterial cell wall.
Adverse effects:
o Rash
o GI disturbances, renal dysfunction
o Antibiotic associated colitis, lethergy
Contraindications: penicillin
hypersensitivity
57. Ciprofloxacin
Fluoroquinoline antibiotic
Inhibits DNA gyrase and topisomerase 1V,
the enzymes necessary for separation of
bacterial DNA – inhibit cell division
Adverse effects:
o Peripheral neuropathy
o Rhabdomyolysis
o Steven Johnson's syndrome
o Hemolytic anaemia
58. Surgical treatment
a) Surgical removal of renal calculi,
bladder calculi
b) Ureteroplasty
c) Reimplatation of ureters if VUR
present
59. Conclusion
Urinary tract infections are the 2nd most
common bacterial infections.
Women are the most infected subjects in
the population.
Development of resistance to antibiotics
by the bacteria result in problems during
the treatment and lead to relapse or
recurrence.
Recent advances such as development of
immunologicals like intranasal vaccines
may result in life time cure of the infection
60. References
• Clinical pharmacy and therapeutics by
Roger Walker, Clive Edwards; 3rd edition;
page 503 – 511.
• Applied therapeutics the clinical use of
drugs by Mary Anne konda- kimble; 8th
edition; page456 – 465.