Recent Advances In The Management Of Juvenile Idiopathic ArthritisNaveen Kumar Cheri
The term “rheumatologicaldisorders” refers to diseases that affect the major connective tissues of the body (e.g. skin, bone, blood vessels, cartilage and basement membrane).
Juvenile Idiopathic Arthritis (JIA) is the most common pediatric rheumatologic disease. It is associated with significant long term morbidity.
It was previously called as, Juvenile Rheumatoid Arthritis (by ACR –American College of Rheumatology) or Juvenile Chronic Arthritis (by ELAR –European League Against Rheumatism).
Recent Advances In The Management Of Juvenile Idiopathic ArthritisNaveen Kumar Cheri
The term “rheumatologicaldisorders” refers to diseases that affect the major connective tissues of the body (e.g. skin, bone, blood vessels, cartilage and basement membrane).
Juvenile Idiopathic Arthritis (JIA) is the most common pediatric rheumatologic disease. It is associated with significant long term morbidity.
It was previously called as, Juvenile Rheumatoid Arthritis (by ACR –American College of Rheumatology) or Juvenile Chronic Arthritis (by ELAR –European League Against Rheumatism).
Case 2S [symptoms] 10 month male presents to pediatrician’s offic.pdfsiennatimbok52331
Case 2
S [symptoms]: 10 month male presents to pediatrician’s office with chief complaint of fever and
rash. In usual state of health until 4 days prior to presentation when developed fever, fussiness
and decreased appetite. Mom thought maybe had thrush again because she noted some white
spots in his mouth a day after the fever started but they went away on their own. Last night she
noticed that his eyes started to appear more red and irritated, is now coughing and very
congested and this morning developed rash on face prompting visit
ROS [review of systems]: as above, no emesis, no constipation or diarrhea, +fewer wet diapers
than usual
PMHx [past medical history]: full term, uncomplicated pregnancy and delivery, neonatal
jaundice but did not require phototherapy, thrush at 6 weeks and 3 months of age treated with
nystatin
SHx [social history]: lives with parents and 2 yo sibling who is enrolled in child care. Flew to
California with family 3 weeks ago to visit grandparents, no other travel hx.
Imm: UTD [up to date]
Exam: T- 39.8 [temperature, C]; R -34 [respiratory rate]; P -120 [pulse]; BP-85/62 [blood
pressure]; Pox-98% in room air [pulse oximetry, oxygenation of blood]
Gen [general]: Alert, fussy infant on mom’s lap, crying with exam
HEENT [head, eyes, ear, nose, throat]: Normocephalic/atraumatic, anterior fontanelle fibrous but
flat, extraocular movements intact, pupils equal and reactive to light, +conjunctival erythema
bilaterally without discharge or crusting, nares congested, oropharynx erythematous with
sloughing of buccal and labial mucosa. Tympanic membranes erythematous but with intact
landmarks and light reflex
Neck: supple full range of motion, +1cm bilateral anterior cervical lymphadenopathy
RESP [respiratory]: mildly tachypneic with fair air exchange all fields, +subcostal retractions no
intracostal or suprasternal accessory muscle use, diffuse crackles audible on auscultation all lung
fields no wheezing or rhonchi
COR [cardiac]: tachycardic, regular, nl s1 and split s2, no murmurs, rubs or gallops
Abdomen: soft, normoactive bowel sounds, nontender non distended, no hepatosplenomegaly, no
masses
GU [genital/urinary]: circumcised tanner I male, no rashes
Skin: diffuse erythematous blanching maculopapular rash most prominent/confluent on face,
neck, and upper trunk, palms and soles spared, no desquamation
Extremities: warm and well perfused
a) What were the spots in the infant’s mouth that the mother mistook for thrush?
b) What is your diagnosis, and which symptoms lead you to this conclusion?
c) Which tests will you order to confirm this diagnosis (give the name and state what is being
measured)?
d) The patient is up to date on his vaccinations, so why was he susceptible to this disease? Where
did he likely contract the disease?
e) In an uncomplicated form, this condition is not usually fatal, but what can cause fatalities for
patients with this infection?
f) A similar patient might be admitted to the hospital or might not fo.
Case presentation of pyelonephritis.pptxMuhammad Asad
case presentation of Pyelonephritis.
A 12-year-old boy presented in ER with a complaint of
Fever for 1 month
Pain in the right flank region for 1 month
Swelling in the right flank region for 15 days.
how we approached the case and went through detailed Hx, examination followed by investigations.
It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
CASE STUDY: ACUTE EXUDATIVE TONSILLITIS
Maria Makiling, RN, FNP-S
NUR 620 Advanced Physical Assessment Mervyn M. Dymally School of Nursing
Charles R. Drew University of Medicine and Science
CASE STUDY: ACUTE EXUDATIVE TONSILLITIS
15
CASE STUDY: ACUTE EXUDATIVE TONSILLITIS
PATIENT INFORMATION: S.J. is a 17-year old Caucasian male. CHIEF COMPLAINT: Sore throat for 2 days
HISTORY OF PRESENT ILLNESS: S.J. was brought in by his mother because of sore throat which occurred two days prior to consult. Mother shared that her son was exposed to a classmate with similar symptoms one day prior to the appearance of his symptoms. S.J. describes his sore throat as constant, burning in nature, 9/10 on the pain scale and worsens with eating and swallowing especially non liquid food. This was also associated with hoarseness, headache, body weakness and high fever (maximum reading of 101.9 F) which breaks off with intake of Tylenol 500 mg every 4 hours as needed. Patient also states that he would experience some relief of sore throat when drinking warm lemon juice. Due to his symptoms progressively getting worse, mother decided to bring him for medical consultation.
ALLERGIES: No known food or drug allergies.
PAST MEDICAL HISTORY: Patient denies any previous hospitalizations and presence of other co morbid medical conditions. Immunization status up to date.
PAST SURGICAL HISTORY: Patients denies any previous surgeries. FAMILY HISTORY: (-) Heart Disease, Kidney pathology, Rheumatic Fever
SOCIAL HISTORY: High school student attending public education, resides with parents and 2 other younger siblings. Denies smoking, alcohol intake, and tobacco or illicit drug use.
SEXUAL HISTORY: Sexually active, in a monogamous relationship with current partner.
REVIEW OF SYSTEMS:
Constitutional: No chills, weight changes, fatigue, weakness, night sweats.
Skin: No rash, discoloration, itching, pruritus, lumps/bumps, nail, or hair changes. Head: (+) headache, no dizziness, lightheadedness, or vertigo.
Eyes: No changes in vision, eye pain, tearing, eye discharge.
Ears: (+) ear pain bilaterally worse with swallowing, no aural discharge, ear fullness, tinnitus, or hearing loss.
Nose/Sinuses: No congestion, nasal discharge, epistaxis, sinus pain, sneezing, Oral: No sores, dental cavities, gum lesions or gingivitis, gum bleeding.
Throat/Neck: (+) sore throat, hoarseness, dysphagia, no neck pain, no neck swelling. Cardiovascular: No chest discomfort, palpitations, orthopnea, shortness of breath.
Respiratory: No dyspnea, cough, hemoptysis, shortness of breath, wheeze. Gastrointestinal: Unable to eat well due to painful swallowing, no abdominal pain,
heartburn, nausea, vomiting, changes in bowel habits or blood in stools.
Genitourinary: No dysuria, hematuria, urinary frequency, incontinence, genital discharge.
Musculoskeletal: No leg pain, cramps, joint pain, joint stiffness, swelling, weakness. Neurological: No headaches, seizures, tremors, numbness, tingling.
Endocrine: N ...
SOAP NOTE
Name:
N.C
Date:
10/26/2020
Time:
09.30 h
Age:
5-year-old
Sex:
M
CC:
"I have sore throat"
HPI:
A 5 y/o Hispanic male presents to the clinic complaining of sore throat that started 3 days ago. Describes that occasionally feels like “piercing or burning” pain that it is constant. Also, that is very painful to swallow. Mother states patient developed cold symptoms (cough, sneezing) about 5 days ago, sore throat started 3 days ago, and fever of 101.5 F began 24h ago. Patient added that the pain varies in intensity, rated anywhere from 8 to 9 on a Wong-Baker scale when eating or drinking, but at this moment rated his pain at 5. Reports that pain is not radiating to any surrounded area and “is better when drinking sips of a cold liquids like water or Kool-Aid or takes Ice cream”. Mother also states that fever somehow is relieved by rest and Tylenol. Confirms that his appetite has decreased in the last 3 days.
Medications:
Tylenol OTC PO PRN
PMH
Allergies: NKDA
Medication Intolerances: None
Chronic Illnesses/Major traumas: None
Hospitalizations/Surgeries: None
Immunizations:
- According to CDC for his age group, he is up to date with the following vaccines
• Influenza 2019
• Tdap 5th dose
• MMR 2nd dose
• Polio IVP 4th dose
• Chickenpox (Varicella) 2nd dose
Family History:
Mother: Alive – no significant medical history
Father: Alive - HTN
Sister: 8 years old healthy
Brother: 2 days old healthy
Social History
Lives with both parents and siblings. Appears comfortable and happy with mother in the room. Neither parents smoke. Patient began kindergarten this year at local public school.
General
Patient reports sore throat, but overall healthy, appropriate weight and height for age, usually very active but mostly lying around the past few days per mom.
Cardiovascular
Denies chest pain or palpitations.
Skin
Denies rash, inflammation, pain, tenderness, or skin lesion.
Respiratory
Denies any cough, wheezing, hemoptysis, dyspnea, pneumonia hx, TB exposure or symptoms per mom, or SOB.
Eyes
Denies use of corrective lenses or glasses, blurred vision, or visual changes of any kind.
ENT
Denies ear pain, hearing loss, ringing in ears, discharge. Reports no sinus problems, or nose bleeding. Complains of sore throat and aggravating pain when swallowing. Goes to dentist every 6 months per mom.
Gastrointestinal
Denies diarrhea, abdominal pain, or heartburn. He had his last bowel movement this morning and goes at least once a day.
Genitourinary
Denies urgency, frequency or burning and pain with urination. Reports no hematuria or change in color of urine. Denies penile pain.
Musculoskeletal
Denies back pain, joint swelling, stiffness, or muscle pain.
Heme/Lymph/Endo
Denies fatigue. Mother states swollen/tender cervical lymph nodes. Patient is appropriate size and weight for his age.
Neurological
Denies any syncope, seizures, transient paralysis, paresthesi.
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Particular’s of the patient
Name : Akhi
Age : 5 years
Sex : Female
Informant : Grandmother
Bed no : 05
Ward : General Paediatrics
Address : Comilla
Date of admission : 10/1/16
3. Chief complaints:
Painful swelling in right thigh for last 01 month
Recurrent attack of itchy skin lesion over whole
body since early infancy
Recurrent episodes of respiratory tract infection &
ear infection from early childhood.
4. History of present illness
According to the statement of informant grand mother the
child developed –
Painful swelling over right thigh which is gradually
increasing in size for last one month and associated
with purulent discharge through a small opening
after spontaneous rupture. On inquiry grandmother
told that she developed recurrent attack of pastular
lesion of various size over various parts of body since
her early infancy.
She has history of recurrent diffuse itchy
erythematous rash over whole body including face,
palm and soles associated with ulceration & oozing
from early infancy with relapse and recurrence.
5. History of present illness
Grandmother also mentioned that the child also
developed repeated respiratory tract and ear
infection since early infancy.
For these illness she visited to several doctors and also
admitted to various clinic and hospital and each time
treated with injectable drugs but couldn’t mention
the name of medicine.
6. History of present illness contd..
There is no history of asthma, conjunctivitis, food allergy,
recurrent diarrhoea, joint pain, bleeding manifestation,
convulsion or unconsciousness or sib death in the family.
8. Birth history:
Born by normal delivery at home at term and birth
history was uneventful
Feeding history:
She is exclusively breast feed baby and now is on family
diet.
Immunization history:
Completed as per EPI schedule
Development history:
Milestone of development is age appropriate
9. Family history:
She is the 1st issue of consanguineous parents. Father is
serving in abroad, Non of the family members suffering
from any significant illness.
Socio-economic history:
She is coming from a lower middle class family, living in
building, using sanitary latrine and drinking tube-well
water.
10. General physical examination
Appearance :Ill looking
Pallor : mild
Jaundice, Cyanosis, Clubbing
Dehydration, Edema
Leuconychia, Koilonychia:
BCG mark : present
Lymphnode: Anterior cervical
lymphnodes including jugulo-digastric
lymphnodes are enlarged, 2/3 in number,
discrete, firm, nontender, not fixed,
Ear : watery discharge is present in both
ear
absent
11. Diffuse eczematous dermatitis
some of which are erythematous excoriated papular in
nature,
some are dry crusted with scab formation,
some are ulcerated with oozing
Skin survey
12. Vital signs
Pulse : 100/min
BP : 80/40 mm HG
Temp : 980 F
Resp rate : 24/min
13. Local examination:
There was an abscess in the front of right thigh
Size : 8 cm X 5cm
tender
Color of overlying skin : reddish
Temperature : normal
Consistency : soft in the consistency
with small opening in the
center with purulent discharge
18. Gastrointestinal system
Inspection :abdomen is distended
umbilicus is centrally placed and everted
Palpation: liver is enlarged about 5 cm from right
costal margin along the mid clavicular line.
nontender, firm in consistency , surface
smooth, margin sharp,
upper border of liver dullness at Rt 5th intercostal
space
no other organomegaly
fluid thrill absent
Percussion: Tympanatic
Auscultation: bowel sound is present and normal
20. Salient features
Akhi, 5 year old girl, 1st issue of a consanguneous
parents got admitted with the complaints of formation
deep seated abscess over right thigh for 1 month, with
the history of recurrent attack of skin abscess, itchy
dermatitis, respiratory tract infection & ear infection
since early infancy. For these illness she had been admitted
to various hospital or clinic and each time treated with
injectable antibiotics. She had no history of other
allergic manifestation like asthma, allergic conjunctivitis,
recurrent diarrhoea, joint pain, bleeding manifestation,
convulsion or unconsciousness.
21. Salient feature contd….
On examination she was ill looking, mildly pale,
BCG mark present, cervical lymphnode of are
enlarged, watery dischagre are coming out from both
ear, anthopometry HAZ: -3.6, WAZ: -2.8, there is
diffuse itchy eczematous lesion over whole body,
and a deep seated skin abscess measuring about 5X8
cm2 is present in anterior aspect of right thigh.
Examination of abdominal system revealed distended
abdomen with hepatomegaly. Other systemic
examination revealed no abnormality.
24. Primary Immunodeficiency Syndrome
most probably Hyper IgE syndrome
Points in favors of primary
immunodeficiency
syndrome
Recurrent boil and abscess
Recurrent otitis media
Recurrent respiratory tract
infection
Required injectable
antibiotics for treatment
Consangunity of marriage
in parents
On examination- abscess
in rt thigh, otitis media
Points in favors of hyper
IgE syndrome
Recurrent intense itchy
eczematous lesion over
skin
Failure to thrive
On examination- diffuse
eczematous lesion
present over whole body
25. Atopic dermatitis
Points in favours Points against
History
Recurrent episodes of
eczematous skin lesion over
whole body associated with
intense itching
Examination
Diffuse eczematous lesion
present over whole body
History
Recurrent abscess
Recurrent RTI
Recurrent otitis media
No associated other allergic
manifestation
No family history of atopy
or allergy
Examination
No lichenification
27. Investigations findings
Investigation findings
CBC HB – 10 gm/dl
WBC – 22x109/L
N- 50%
L- 20%
E- 25%
Platelet- 600X109/L
ESR- 81 mm in 1st hour
PBF RBC- microcytic hypochromic with
neutrophilic leukocytosis with eosinophilia
and thrombocytopenia
Urine R/M/E Normal findings
Pus for Gram staining Reactive organism are found,
Pus for AFB Negative
Pus for C/S No growth
28. Investigation cont…
Investigation findings
Ig E 2650 IU/ml
Ig G 13.9 gm/dl ( 7- 16 g/L )
Ig M 0.433 gm/dl ( 0.4- 2.3 g/L )
Ig A 2.29 gm/dl ( 0.7 - 4 g/L )
Anti HIV (ELIZA) Negative
NBT Positive
CXR Normal findings
30. Management
Treatment given
Inj Ceftriaxone
Syrup flucloxacillin
Syrup Chlorpheniramine
Syrup Ranitidine
Tablet montelukast
Moisturizing Body Lotion
Incision & drainage of pus and dressing of wounds
31. Follow up on 19/1/16 Day10
S O A P
Itching
persisting
Afebrile
Vital parameters
are normal
skin: itchy
eczematous rash
persists gradually
subsiding
Abscess: discharge
reduced and
wounds are
gradually healing
Improving Discharge the
patient with
prophylactive
long term
penicillanse
resistance
anti-
staphylococcal
antiboitics .