Ventilator-acquired pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in critically ill patients on mechanical ventilation. It is caused by pathogenic bacteria spreading from the oropharynx to the lungs. Risk factors include prolonged ventilation, comorbidities, and supine positioning. Diagnosis involves assessing symptoms, chest imaging, and microbiological testing of respiratory samples. Treatment involves timely administration of broad-spectrum antibiotics, with later de-escalation based on culture results. Prevention focuses on minimizing ventilation time, proper positioning, oral care, and ventilator bundles.
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
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.
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
3. INTRODUCTION
• Ventilator acquired pneumonia (VAP) is a significant cause of
morbidity and mortality in critically unwell patients within the
intensive care unit who undergo invasive mechanical ventilation via
an endotracheal tube or tracheostomy.
• Early diagnosis and adoption of practices known to prevent VAP can
reduce mortality and decrease the development of multi resistant
organisms.
4. DEFINTION
• VAP is a type of hospital acquired pneumonia that occurs within 48
hours or more after endotracheal intubation which was not present
at the time of admission
5. INCIDENCE
• VAP is common in critical care patients and is responsible for around
half of all antibiotics given to patients in ICUs.
• Figures quoted by the International Nosocomial Infection Control
Consortium suggest that the overall rate of VAP is 13.6 per 1000
ventilator days.
• However, the individual rate varies according to patient group, risk
factors, and hospital setting.
• The average time taken to develop VAP from the initiation of MV is
around 5 to 7 days, with a mortality rate quoted as between 24% and
76%.
6. RISK FACTORS OF VAP
• HOST RELATED; Ongoing pathology, Immunosuppression, Malnutition,
advanced age, supine position, level of consciousness, medications
• HEALTHCARE PERSONEL RELATED:Improper hand washing technique,
failure to change gloves and mask between patients
• DEVICE RELATED: Invasivr mechanical ventilation, mechanical ventilation
for more than 48hrs, reintubations, NG tube or orogastric tube placement,
use of humidifiers
8. PATHOPHYSIOLOGY
• The key to the development of VAP is the presence of an ETT or
tracheostomy, both of which interfere with the normal anatomy and
physiology of the respiratory tract, specifically the functional
mechanisms involved in clearing secretions (cough and mucociliary
action).
• Intubated patients have a reduced level of consciousness that impairs
voluntary clearance of secretions, which may then pool in the
oropharynx.
9. PATHOPHYSIOLOGY
• This leads to the macroaspiration and microaspiration of
contaminated oropharyngeal secretions that are rich in harmful
pathogens.
• Normal oral flora start to proliferate and are able to pass along the
tracheal tube, forming an antibiotic-resistant biofilm which eventually
reaches the lower airways.5
10. PATHOPHYSIOLOGY
• Critically unwell patients exhibit an impaired ability to mount an
immune response to these pathogens, leading to the development of
a pneumonia.
• The presence of additional predisposing factors such as pulmonary
oedema in these patients can also accelerate the process.
11. TYPES OF VAP
• Early-onset VAP, occurring within the first four days of MV, is usually
caused by antibiotic-sensitive community-acquired bacteria such
as Haemophilus influenza, Streptococcus pneumonia and
Staphylococcus aureus
• VAP developing more than 5 days after initiation of MV is usually
caused by multidrug–resistant bacteria such as Pseudomonas
aeruginosa, MRSA, Actinobacter,Enterobacter
13. PREVENTION
• VAP prolongs the duration of stay in the ICU, thereby increasing the
cost of patient management.4 It therefore makes the prevention of
VAP a priority in the management of critically unwell patients.
• Basic preventative measures include minimising excessive time on a
ventilator via the implementation of an early weaning protocol with
regular sedation breaks and the avoidance of routine or scheduled
ventilator circuit changes.
14. PREVENTION
• Appropriate semirecumbent positioning of patients, with a 30- to 45-
degree head-up approach, reduces the incidence of microaspiration
of gastric contents when compared with patients nursed in a supine
position.
• Stress ulcer prophylaxis raises gastric pH, which is detrimental to the
innate immunological protection provided by gastric acid.
• Stopping stress ulcer prophylaxis in low-risk patients (those patients
absorbing feed without a history of gastrointestinal bleeding) is
recommended.
15. • Subglottic suction ports have been shown to reduce the incidence of
VAP and to significantly reduce the use of antibiotics.
• If it is anticipated that a patient will be mechanically ventilated for
more than 72 hours, consideration for insertion of a tube with
subglottic drainage should be made.
16. • Microaspiration can also be reduced by the maintenance of
endotracheal tube airway cuff pressure at 20 to 30 cm H2O and the
use of positive end-expiratory pressure.
• Decontamination of the digestive tract has been studied as a method
of reducing the incidence of VAP by decreasing colonisation of the
upper respiratory tract.
• Methods used include antiseptics, such as chlorhexidine in the
oropharynx, and
17. • The aim of this method is to eradicate the oropharyngeal or
gastrointestinal carriage of potentially harmful pathogens, such as
aerobic gram-negative microorganisms and methicillin-
sensitive Staphylococcus aureus.
• These methods were shown to reduce the mortality of ICU patients in
hospitals with low antibiotic resistance rates.
18. • However, SDD has never become mainstream practice, largely due to
concerns of long-term microbial ecology within the ICU and selection
of drug-resistant organisms.
• SOD using chlorhexidine mouthwash did become routine practice,
although it has more recently been restricted to VAP prevention care
bundles for patients who have undergone cardiac surgery.
• Recent reviews have shown a nonsignificant trend towards worse
outcomes in noncardiac patients, although the reason for this is
unclear.
• Therefore in noncardiac patients, chlorhexidine mouth care has been
removed from many mainstream care bundles.
19. • Regular oral care with basic hygiene aims to reduce dental plaque
colonisation with aerobic pathogens.
• Although there is limited evidence for its use, it is unlikely to cause
harm. Probiotic use has not conferred any significant impact on
mortality rates.
20. • VAP prevention bundles provide an effective method by which to
reduce individual unit rates of VAP.
22. DIAGNOSIS
• VAP classically presents with symptoms such as fever, purulent
respiratory secretions, rising inflammatory markers, respiratory
distress, and worsening respiratory parameters (reduced tidal
volume, increased minute ventilation, and hypoxia).
• Certain groups of patients are vulnerable to atypical organisms and
eachlikely pathogen before commencing antibiotics, patient demands
a full diagnostic evaluation to identify the
23. • Every patient exhibiting signs of VAP should have a chest X-ray and
those patients who exhibit changes consistent with infection should
have a sample of their respiratory tract secretions sent for Gram stain,
culture, and sensitivity.
• A normal chest X-ray should prompt the clinician to consider an
alternative diagnosis.
24. • Prior to commencement of broad-spectrum antibiotics, a patient
must have respiratory samples sent to microbiology.
• This can be performed either by nonbronchoscopic sampling
(tracheobronchial aspiration or mini-bronchoalveolar lavage) or via
bronchoscopic sampling (bronchoalveolar lavage or protected
specimen brush).
• These techniques have been compared and the results indicate that
bronchoscopic sampling reduces respiratory tract contamination of
samples and provides a more accurate representation of likely
pathogens; however, impact on overall morbidity or mortality has not
been demonstrated.
25. • This may allow a more targeted antibiotic regime and earlier de-
escalation and cessation of antibiotic therapy.
• Inflammatory markers such as procalcitonin and C-reactive protein
lack sensitivity and specificity for the diagnosis of pneumonia but
they can help decision making and reduce the overuse of antibiotics.
• Current research aiming to improve diagnosis in VAP include novel
biomarkers and fibre-optic microbial staining.
27. TREATMENT
• Treatment of VAP relies on knowledge of common pathogens, patient
risk factors (for example immunosuppression and underlying
respiratory condition), and previous microbiology specimens.
Empirical treatment for VAP should include antibiotics with cover
against Pseudomonas aeruginosa,Staphylococcus aureus, and gram-
negative bacilli, with antibiotics administered in a timely fashion.