Urinary tract infections are common, especially in children under 1 year old and females. E. coli is the primary cause. UTIs usually occur from ascending bacterial infection traveling from the anus to the bladder. Symptoms depend on the location of infection, ranging from abdominal pain and fever in pyelonephritis to dysuria and urinary frequency in cystitis. Diagnosis involves urinalysis and urine culture. Treatment consists of antibiotics targeting the identified bacteria. Recurrent infections can lead to long term issues like kidney damage, so prevention focuses on managing underlying conditions and risks.
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.
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.
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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
4. Prevalence and Etiology
The prevalence varies with age.
Most common in children under age 1 yr
A febrile symptomatic UTIs in children over age 1 yr is~8%
In febrile infants is 7%.
During the first yr of life, Male:Female ratio is 2.8 : 5.4.
Beyond 1-2 yr, there is a female preponderance, Male:Female ratio of 1 : 10
4
5. Much more common in uncircumcised males - 20% in febrile uncircumcised
males under age 1 yr.
In females, the first UTI usually occurs by the age of 5 yr, with peaks during
infancy, toilet training, and onset of sexual activity.
5
6. Primarily by colonic bacteria -Escherichia coli(54–67% ) ,Klebsiella spp ,Proteus
spp, Enterococcus, and Pseudomonas
Others - Staphylococcus saprophyticus, group B streptococcus, Staphylococcus
aureus, and Salmonella spp ,Candida spp ,adenovirus
6
7. Pathogenesis and Pathology
Nearly all UTIs are ascending infections
Fecal flora, colonize the perineum, and enter the bladder via the urethra.
In uncircumcised males, the bacterial pathogens arise from the flora beneath the
prepuce
Rarely, renal infection occurs by hematogenous spread
7
8. Defect in anti reflux mechanism that prevents urine in the renal pelvis from
entering the collecting tubules
Passive anti reflux mechanism –passive compression of the ceiling of intravesical
ureter against underlying detrusor muscle ,intravesical ureter length and diameter
Active anti reflux mechanism –active shortening of the longitudinal muscle layer
of transmural and submucosal ureter –active valve
8
10. The presence of bacterial pili or fimbriae on the bacterial surface
Two types of fimbriae, type I and type II.
type II - Mannose resistant, P fimbriae are more likely to cause pyelonephritis
Between 76% and 94% of pyelonephritogenic strains of E. coli have P fimbriae,
compared with 19–23% of cystitis strains.
10
11. Classification and Clinical Manifestations
Pyelonephritis and cystitis.
Focal pyelonephritis (lobar nephronia) and renal abscesses -less common.
11
12. Pyelonephritis
Involvement of the renal parenchyma is termed acute pyelonephritis
No parenchymal involvement, the condition may be termed pyelitis.
Pyelonephritic scarring
Acute lobar nephronia (acute lobar nephritis) - localized renal parenchymal, more
commonly occurs in older children, early phase of renal abscess .
12
13. Any or all of the following: abdominal, back, or flank pain; fever ,malaise,
nausea,vomiting ,and, occasionally, diarrhea.
Fever may be the only manifestation:a temperature > 39°C without another source
, lasting more than 24 hr for males and more than 48 hr for females
Newborns - poor feeding, irritability, jaundice, and weight loss.
13
14. Renal abscess - following hematogenous spread with S. aureus or pyelonephritic infection caused by the
usual uropathogens.
Most abscesses are unilateral , right sided and can affect children of all ages
14
15. Perinephric abscess
Diffuse throughout the capsule and is not walled off
Contiguous infection in the perirenal area (e.g., vertebral osteomyelitis, psoas
abscess) or pyelonephritis that dissects to the renal capsule
The most common organisms -S. aureus and E. coli.
Abnormal findings may not be seen on urinalysis or culture.
15
16. Xanthogranulomatous pyelonephritis
Granulomatous inflammation with giant cells and foamy histiocytes
As a renal mass or an acute or chronic infection.
Renal calculi, obstruction, and infection with Proteus spp. or E. coli
Usually requires total or partial nephrectomy.
16
17. Cystitis
Only bladder involvement
Dysuria, urgency, frequency, suprapubic pain, incontinence, and possibly
malodorous urine.
Does not cause high fever and does not result in renal injury.
17
18. Uncomplicated cystitis — limited to the lower urinary tract ,children older than
two years with no underlying medical problems or anatomic or physiologic
abnormalities.
Complicated cystitis — Coexisting upper UTI, multiple-drug resistant
uropathogens, or hosts with special considerations ( Anatomic or physiologic
abnormality of the urinary tract, indwelling bladder catheter, malignancy, diabetes)
18
19. Acute hemorrhagic cystitis
Uncommon in children
E. coli ,adenovirus types 11 and 21( more common in boys; it is self-limiting, with
hematuria lasting approximately 4 days )
Patients receiving immunosuppressive therapy -adenoviruses and polyomaviruses
(i.e., JC virus and BK virus)
Eosinophilic cystitis or interstitial cystitis
19
20. Diagnosis
Suspected based on symptoms or findings on urinalysis, or both
Urine culture is necessary for confirmation and appropriate therapy
Ways to obtain a urine sample-toilet-trained children(a midstream urine sample) ,
In uncircumcised males(the prepuce must be retracted), not toilet trained - a
catheterized or suprapubic aspirate urine sample
If the culture shows > 50,000 colony-forming units/mL of a single pathogen
(suprapubic or catheter sample) and the urinalysis has pyuria or bacteriuria in a
symptomatic child.
20
22. Microscopic hematuria - acute cystitis
WBC casts
Pyuria -A WBC count on urinalysis above 3-6 WBCs/high-power field is
indicative of infection
Sterile pyuria - positive leukocytes, negative culture,
May occur in partially treated bacterial UTIs, viral infections, urolithiasis, renal
tuberculosis, renal abscess, urinary obstruction, urethritis, inflammation near the
ureter or bladder
22
23. Refrigeration is a reliable method of storing the urine until it can be cultured
Leukocytosis and neutrophilia are noted on the complete blood count
An elevated serum erythrocyte sedimentation rate, procalcitonin level, and C-
reactive protein are common
23
24. Bacteremia - 3–20% of patients and is most common in infants less than 90 days
old and in any child with obstructive uropathy.
Atypical features - failure to respond with in 48 hr of appropriate antibiotics, poor
urine flow, an abdominal flank or suprapubic mass, non–E. coli pathogen,
urosepsis, and an elevated creatinine level.
24
25. Imaging Findings
Imaging is not needed to make the clinical diagnosis of UTI or pyelonephritis
Acute lobar nephronia or renal abscess
Ultrasound is the first-line
CT scan
25
27. The AAP practice parameter recommends initial ultrasound of the kidneys, ureters,
and bladder for children 2-24 mo with a first episode of UTI.
VCUG is indicated only if the ultrasound study indicates hydronephrosis, scarring
or other findings suggestive of reflux or obstructive uropathy, or if the patient has
other atypical complex features , recurrent febrile UTI
27
28. Treatment
Acute cystitis
3- to 5-day course of therapy with trimethoprim-sulfamethoxazole (TMP-SMX)
(6-12 mgTMP/kg/day in 2 divided doses)
Nitrofurantoin (5-7 mg/kg/24 hr in 3-4 divided doses)
Amoxicillin (50 mg/kg/24 hr in 2 divided doses)
28
29. Acute febrile UTIs
7-14 days , oral and parental routes are equally efficacious
Dehydrated, are vomiting, are unable to drink fluids, have complicated infection,
or in whom urosepsis is a possibility should be admitted to the hospital for
intravenous (IV) rehydration and IV antibiotic therapy
Ceftriaxone (50 mg/kg/24 hr, not to exceed 2 g) or cefepime (100 mg/kg/24 hr q
12 h) or cefotaxime (100-150 mg/kg/24 hr in 3-4 divided doses)
29
30. Oral 3rd-generation cephalosporins
Urine cultures are typically negative within 24 hr of initiation of antibiotic therapy
Acute lobar nephronia is treated with the same antibiotics as pyelonephritis. The
duration of treatment is recommended for 14-21 days.
30
31. Renal or perirenal abscess or with infection in obstructed urinary tracts- surgical or percutaneous
drainage in addition to antibiotic therapy
Long-term antibiotic prophylaxis - Neuropathic bladder, urinary tract stasis and obstruction, severe VUR
, and urinary calculi.
31
32. Long term consequence
Kidney loss - 10–20% of cases of renal abscess
Arterial hypertension
End-stage renal insufficiency
The rate of renal scarring increases between days 2 and 3 of fever, number of
episodes of pyelonephritis and with the grade of reflux.
32
33. Prevention of Recurrences
Bowel and bladder dysfunction
Constipation
Intermittent clean catheterization
Treat underlying causes
33
Risk factor for renal insufficiency or end-stage renal disease- only 2% of children with renal insufficiency report a history of UTI.
grade III, IV, or V VUR
and a febrile UTI, 90% have evidence of acute pyelonephritis on renal
scintigraphy or other imaging studies , toilet training because of bowel–bladder dysfunction
Pyuria may be less likely with certain pathogens (eg, Enterococcus species, Klebsiella species, P. aeruginosa)
Positive nitrites on dipstick analysis; nitrites are produced by Enterobacteriaceae (eg, E. coli, Klebsiella, and Proteus)
TMP-SMX prophylaxis for patients with a history of UTI and diagnosed VUR