tuberculous Meningitis treatment and complications
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Symptomatic therapy: Raised intracranial pressure- 20% Mannitol i.v 0.5 g/kg every 4-6 hr for maximum 6 doses. Convulsions-Diazepam i.v followed by phenytoin. Dyselectrolytemia-Maintenance fluids. Hydrocephalus and persistent decerebration-Ventriculocaval shunt.
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Rheumatoid arthritis management
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2. Current therapeutic approaches for rheumatoid arthritis focus on early, aggressive intervention and include medications such as DMARDs, biologics, corticosteroids, and surgery.
3. DMARDs are first-line medications and include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Biologics that target cytokines like TNF-alpha and IL-6 are used if DMARDs are ineffective or for severe disease.
Anti tubercular drugs
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Epiliepsy PPT lecture and it treatment, causes
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Pharmacological and non pharmacological treatment of primary headaches
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This document provides information on the management of migraine. It discusses:
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Acute central nervous system infection
Encephalopathy => cerebral dysfunction due to circulatory toxins, poisons, abnormal metabolites.
Intrinsic biochemical disorder affecting neurons without inflammatory response
Inflammation of meninges – meningitis
Involvement of brain parenchyma – meningoencephalitis
PATHOGENESIS AND CLINICAL FEATURES OF TB MENINGITIS
Tuberculous Meningitis,
Meningitis is a complication of childhood TB
More common at the age of 6 and 24 months of age
There is usually a focus of primary infection or miliary tuberculosis.
If untreated, high frequency of neurological sequelae and mortality occurs.
Investigations of encephalitis
VIRAL MENINGOENCEPHALITIS
CSF PRESSURE : Normal or Slightly raised (80-150 mm of H20)
LEUCOCYTES : few-1000 cells/mm3 - Initially poly morpho nuclear later mononuclear cells predominate
PROTEIN : Usually 50 -200 mg/dL
GLUCOSE : Normal or slightly reduced
ACUTE DISSEMINATED ENCEPHALOMYELITIS
CSF PRESSURE : Normal or Slightly raised
LEUCOCYTES: 100 cells/mm3, lymphocytosis
PROTEIN : Mildly elevated
GLUCOSE : Normal
Investigations of acute bacterial meningitis
csf findings:
Elevated pressure , turbid.
Elevated cell count >1000/mm3 , mostly polymorphic neutrophil.
Protiens are elevated above 100mg/dl.
Sugar is reduced below 50% of blood sugar level or below 40mg /dl.
Microspic examination of sediments with gram stain helps to identify organisms.
Collect CSF for culture.
In partially treated cases CSF is clear with more lymphocytes, culture is usually sterile.
Acute bacterial meningitis - clinical presentation
signs and symptoms:
Projectile vomiting
Shrill cry
Bulging fontanel
Altered sensorium
Seizures
Photophobia
Hypertonia
Neck rigidity
Kernig sign and Brudzinki sign positive
FUNDUS: Congestion, Pappilloedema
investigation of tuberculous bacterial meningitis
CSF analysis:
Elevated csf pressure (30-40cm h20)
Appearance clear or xanthochromic
Lymphocytic pleocytosis(100-500 cells/mm3)
Protein (>40mg/dl),mild hypoglycorrhachia
Chloride(>600mg/dl)
Low glucose concentration (<2.2mmol/L)
Encephalitis - clinical presentation
Is an inflammatory process of brain parenchyma.
Occurs most often in the first year of life
M/C in world and in INDIA _ Japanese encephalitis
In immunocompetent host- Vaicella , EBV, herpes
treatment of acute bacterial meningitis final
OUTLINE:
*INITIAL STABILIZATION
*ANTIBIOTICS THERAPY
*STEROIDS
*ICP MANAGEMENT
*SYMPTOMATIC THERAPY
*PROGNOSIS AND PREVENTION
INITIAL STABILIZATION
•
Airway, breathing and circulation must be
maintained
•
Correct shock, respiratory distress , multiple
organ system failure
•
Paediatric intensive care unit (PICU) until the
child is stable.
•
Monitoring of pulse rate, BP and respiratory rate
•
Frequent neurologic assessment
Cranium- anatomy of basi-cranium, dural venous sinus
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Neurocranium is the bony case of the brain and meninges. It is formed by a series of eight bones:
Unpaired: Frontal, Ethmoid, Sphenoid & Occipital
Paired : Temporal, Parietal
Ethmoid bone relatively minor contribution
ovary - Anatomy, histology and embryological development of ovary
Overview
*Anatomy
Location
Peritoneal relation
External features
*Blood supply
*Lymphatics drainage
*Nerve supply
*Embryology
*histology
Organic nitrates - pharmacology
These agents are simple nitric and nitrous acid esters of polyalcohols. Otherwise called, Nitro-vasodilators
Nitroglycerin may be considered the prototype of the group.
Important molecular donors of exogenous nitric oxide.
Denitration of the organic nitrates to liberate nitric oxide.
Relax smooth muscle (especially vascular smooth muscle, but also other types including oesophageal and biliary smooth muscle).
Classification breast tumour
This document outlines the classification of breast tumours according to histopathology, grade, stage, receptor status, and DNA. It describes the WHO histological classification including epithelial and stromal tumours of the breast, as well as tumours of the male breast and nipple. Benign and malignant epithelial lesions are defined. Malignant lesions include carcinoma in situ (DCIS and LCIS) and invasive carcinoma. Molecular subtypes and specific tumour types such as lobular carcinoma are also detailed. The classification of stromal tumours, tumours of the male breast, and nipple are summarized.
Adverse effect of Phenytoin
It is a non sedating oral antiepileptic drug.
Fosphenytoin :
Used in status epilepticus
water soluble prodrug of phenytoin
i.V administration
anatomy of Para nasal sinus with clinical anatomy
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Lined by pseudo stratified columnar epithelium
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pathological aspects of paget's disease of nipple with excellent animation for progress of paget's disease. all the points derived from standard reference books.
Diabetic foot ulcer
proper clinical presentation of diabetic foot with photographic picture. each point analysed from surgical manual of Das.
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PATHOGENESIS AND CLINICAL FEATURES OF TB MENINGITIS
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Giridhar Meka - https://www.linkedin.com/in/giridharmeka
Priya Shaw - https://www.linkedin.com/in/priya-shaw
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tuberculous Meningitis treatment and complications
- 3. The child is hospitalised preferably for first 2 months or until they are clinically stabilized. Short course chemotherapy not recommended. Total duration is 12 months. Initiation phase HRZE 2 months Continuation phase HR 10 months
- 4. DRUGS DOSAGE Isoniazid (H) 5 mg/kg/day Rifampicin (R) 10 mg/kg/day Pyrazinamide (Z) 30mg/kg/day Ethambutol (E) 15-20mg/kg/day Streptomycin (S) 30-40mg/kg/day
- 5. In acute phase of illness, parenteral dexamethasone (0.15mg/kg/dose) is given. Then switched over to oral prednisolone. Oral steroids continued for 6 weeks and tapered over next 2 weeks. Rationale Steroids reduce the intensity of cerebral edema, arachnoiditis,fibrosis and spinal block.
- 6. Raised intracranial pressure- 20% Mannitol i.v 0.5 g/kg every 4-6 hr for maximum 6 doses. Convulsions-Diazepam i.v followed by phenytoin. Dyselectrolytemia-Maintenance fluids. Hydrocephalus and persistent decerebration-Ventriculocaval shunt.
- 7. Intellectual disability Seizures Motor and cranial nerve deficits
- 8. Hydrocephalus Optic atrophy Arachnoiditis
- 10. BCG vaccination offers a protective effect (approx.64%)against TBM. Imporvement in weight for age was associated with decreased risk of the disease.
- 11. Poorer in younger children. Untreated cases die within 4-8 weeks Stage Mortality Neurological deficits Stage 1 Recovery - Stage 2 20-25% 25% of survivors Stage 3 50% All survivors
- 12. Duration of ATT is for 12 months Indications for steroids in TB TB Meningitis Massive pleural effusions Pericarditis and pericardial effusions Presenting with hydrocephalus as a complication-suspect TB Meningitis