Hospital infections

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What are Hospital acquired infections

An infection acquired in hospital by a patient who was admitted for a reason other than that infection . An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility 

Nosocomial Infections

Nosocomial comes from the Greek word nosokomeion  meaning hospital (nosos = disease, komeo = to take care of). This type of infection is also known as a hospital-acquired infection (or more generically healthcare-associated infections). 

Update on Troponin

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TROPONIN: definition

Troponin is a hard rock band out of Harrisburg, PA. The songs and lyrics go hand in hand with sweet melodic hooks paired with thought provoking words to fast, aggressive riffs accompanied by ominous phrases. The band began in May 2009, when bass player, Junior Gipe, suffered a heart attack during the first practice, which inspired the band name. Both the group and those who come in contact with them should take note and live every day to the fullest (Facebook).

Cardiac Markers: brief Chronology

-Karmen (1954) increased levels of SGOT in serum of patients with AMI

-1960’s- LDH (now LD) showed to have greater cardiac specificity compared to SGOT

-Rosalki (1967) CK activity

-Sobel and Roberts (1972-6)- CK-MB activity

-Ladenson (1986)- MB-CK mass assay (“Conan antibody”)

-Cummings (1987)- cTnI assay-abandoned

-Katus (1987)- asaay for cTnT

-Ladenson (1992)-assay for cTnI

Good Laboratory Practice

What is GLP?


Good Laboratory Practice is an essential part of Good Manufacturing Practice detailed in Schedule M to the Drugs   Cosmetic Rule. It involves a number of good practices in the Quality Control laboratory which are to be undertaken to carry out an analysis with a defined degree of Accuracy   Precision.


Importance of G L P



Since raw materials, packaging materials, intermediates and finished products are ultimately released based on the analytical results generated in the Q.C. Laboratory,  Accuracy, Precision and Reliability of these results are of paramount importance.

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Quality Assurance Function In a Drug Industry

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What is Quality?

Quality is degree to which a set of inherent characteristics fulfills requirements.

Characteristics : inherent characteristics of a product, process or system related to requirement.

Requirement : need or expectation that is stated, generally implied or obligatory.

Quality Control 

      Quality Control is the part of Quality management focused on fulfilling quality requirements

Quality Assurance

        Quality Assurance is the part of the Quality Management focused on providing confidence that quality requirements will be fulfilled.

In other words, Quality Assurance means to assure quality in a product so that a customer can buy it with confidence and use it for a long period of time with confidence and satisfaction.

It takes ten or more years to build confidence in your products, but that confidence can be lost overnight.

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Quality Control Function for Pharmaceutical Industry

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Introduction

What is Quality?

Quality is degree to which a set of inherent characteristics fulfills requirements.

Characteristics : inherent characteristics of a product, process or system related to requirement.

Requirement : need or expectation that is stated, generally implied or obligatory.

Quality Assurance

Quality Assurance is the part of the Quality Management focused on providing confidence that quality requirements will be fulfilled.

In other words, Quality Assurance means to assure quality in a product so that a customer can buy it with confidence and use it for a long period of time with confidence and satisfaction.

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GMP for API (ICH Q7A)

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ICH , the international body on harmonization od drud standards and regulatories published the standard ICH Q7A for Good Manufacturing Practices for Pharmaceutical Bulk Drugs. This presentation can of immense use for training of middle level managers engaged in pharma industry and academia.

Sleep apnoea

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Basic Sleep Hygiene

-Good sleep hygiene is critical for one’s overall physical and mental health.

-Your body can be compared to a battery - it needs to be re-charged on a regular basis or it will get run down and maybe even die!

-It is best to go to bed at a regular time each night and get up at a regular time every morning – 7 days a week.

-The body needs 7 - 8 hours of quality sleep every night. 

-Your overall health will pay the price eventually if you are constantly sleep deprived

Definitions

-Apnoea : Cessation of airflow for greater than 10 seconds with continued chest and abdominal effort.

-Hypopnea : Decrease in amount of air breathed (some say by 50%) with a desaturation of at least 3%.

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DKA

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Diabetes 

=1552 BC, Diabetes 1st Described In Writing on 3rd Dynasty Eqyptian papyrus by physician Hesy-Ra: mentions polyuria as a symptom.

=250 BC, Apollonius of Memphis coined the name "diabetes” meaning "to go through" or siphon. He understood that the disease drained more fluid than a person could consume. 

Diabetes Mellitus

-Gradually the Latin word for honey, "mellitus," was added to diabetes because it made the urine sweet.

 -Up to 11th century diabetes was commonly diagnosed by “water tasters” who drank the urine of those suspected of having diabetes, as it was sweet-tasting

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Leukaemia

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Leukaemia

-“White blood” – leucos/aemia

-1827 Alfred Velpeau

63 year old florist, fever, weakness, urinary stones, hepatosplenomegaly

Blood “like gruel”

-1845 JH Bennett – patients with enlarged spleens and changes in the colour of the blood – “Leucocythaemia”

-1856 Virchow observed the white cells with a microscope – “Leukaemia”

Acute Leukaemia

=Rapidly progressive

=Proliferation of primitive “blast” cells

=Acute myeloblastic (myeloid) leukaemia

“Acute non-lymphoblastic leukaemia”

=Acute lymphoblastic leukaemia

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Anaemia

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INTRODUCTION

-Anaemia –  Decreased level of Hb in blood below reference level for age and sex with plasma level not above normal value

-Spurious Anaemia – Raised plasma volume with normal or slightly raised Hb e.g. pregnancy

-Masked Anaemia – Immediately after major bleed

-Spurious Polycythemia – due to decreased plasma volume-dehydration

-Anemia is not a disease but a sign of some underlying disease

TYPES OF ANAEMIA

---Based on RBC indices

-Decreased MCV-hypochromic microcytic

-Increased MCV-macrocytic

-Normal MCV-normochromic normocytic

---Based on cell proliferation

-Abnormally low Retic Count

-Retic Count normal to condition

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Cell structure

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Summary of cells:



-The discovery of the cell
-What is the cell?
-cell theory
-The commons in 
-animal and plant cells


What is the cell?
A cell is the basic unit that is capable of performing life functions.

Cell Theory

-Cell theory states that the basic unit of structure and function of all living organism is the cell. 

-All cells arise from pre-existing cells by cell division. 

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Neuropharmacology

Synthesis of Acetylcholine

-Acetylcholine synthesis is the rate limiting step

-Choline is the rate limiting factor in the synthesis of acetylcholine

-Inactivation occurs by degradation, then reuptake

Muscarinic ACh Receptors

-Antagonists: Atropine. Symptoms: Dry as a stone, red as a beat, mad as a hatter, Constipation, tachycardia, fever, mydriasis etc.

-Trihexiphenidyl is M1 blocker used in PD for tremor

    Ipratropium is M3 blockers used in asthma/COPD

-Agonists: Bethanecol, carbachol etc. Rarely used in ileus, atonic bladder.

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Cerebral palsy

Objectives

-Define cerebral palsy.

  ● appreciate magnitude of the problem.

  ● know common handicaps associated with CP

  ● know etiology of the disease.

  ● be able to classify a case of cerebral palsy. 

  ● gives relevant differential diagnosis.

  ● gives relevant investigations.

  ● identify goal of management.

  ● identify types of management to be provided

  ● know prognosis of the disease. 

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Dyslipedemias

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Alteraciones en la regulación de la temperatura

Ejercicio aeróbico:



-El ejercicio aeróbico  ayuda a mejorar  el uso del oxígeno durante el ejercicio prolongado
-Vg; caminata, correr, andar en bicicleta, nadar.
-No incrementa la masa muscular

Ejercicio isométrico

-Cargar pesas & realizar movimientos repetidos en contra de resistencia.
-Mejora la fuerza muscular e incrementa la masa muscular

Ejercicio flexible
-Mejora la flexibilidad de tendones, la amplitud del movimiento articular y el rendimiento muscular.
-Se recomienda por lo menos 2 – 3 veces a la semana.

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Blood Cells

Introducción

-Tejido conectivo especializado

-Células sanguíneas

-7 – 8% del peso total

-5 – 6 Litros (adulto)

PLASMA

=Transporta hormonas

=Facilita el intercambio de mediadores químicos

=Participa en el equilibrio A/B

=Proteínas plasmáticas: regulación osmótica

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Patient safety

Patient safety is a serious global public health issue. In recent years, countries have increasingly recognized the importance of improving patient safety.

Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care. The harm can be caused by a range of errors or adverse events. In October 2004 WHO launched  the world alliance for patient safety in response to WHO Assembly  of 2002 urging WHO and members States to pay the closest possible attention to the problem on patient safety

In developing countries, the probability of patients being harmed in hospitals is higher than in industrialized nations. The risk of health care-associated infection in some developing countries is as much as 20 times higher than in developed countries.

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Pulmonary function test

Pulmonary function tests are a group of test that measure how well the lungs take in and release air and how well they move oxygen into the blood.(it is a non invasive)

In a spirometry test, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time.

Lung volume measurement can be done in two ways:

-The most accurate way is to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.

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Medical transducers

An Introduction to Sensors and Transducers

=The words 'sensor' and 'transducer' are both widely used in the description of measurement systems

=The word 'sensor' is derived from entire meaning 'to perceive' and 'transducer' is from transducer meaning 'to lead across'.

=A dictionary definition of 'sensor' is `a device that detects a change in a physical stimulus and turns it into a signal which can be measured or recorded;

=A corresponding definition of 'transducer' is 'a device that transfers power from one system to another in the same or in the different form'. 

=A sensible distinction is to use 'sensor' for the sensing element itself and 'transducer' for the sensing element plus any associated circuitry. 

=All transducers would thus contain a sensor and most (though not all) sensors would also be transducers. 

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Ultrasound

why medical imaging is required?



=Medical imaging  provides a pictorial status of particular organ which is to be treated   
=It makes a surgical targets more clear and precise
=It provides a pictorial status of fetus development  right from 4th weak to 36th- 38th week  
=It make therapeutic targets easy to detect and treat 


TYPES OF  MEDICAL IMAGING  WIDELY USED 

-X-RAY
-MAMOGRAPHY
-CONTRAST  RADIOGRAPHY
-ULTRA SOUND
-CT SCAN
-MRI
-SPECT(SINGLE PHOTON EMMISION TOMOGRAPHY)
-PET(POSITRON EMISSION TOMOGRAPHY)

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Catharization

WHAT WE WOULD COVER….

-WHAT  IS CATHETER

-WHY CATHETERS ARE REQUIRED

-TYPES OF CATHETERS

-WHAT  IS CATHARIZATION  AND ASSOCIATED TEQNIUES 

-Pulmonary Artery Catheterization

-COMPLICATIONS WITH CATHRIZATION

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, injection of fluids, or access by surgical instruments.

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Respiratory dialysis ( Hemolung)

RESPIRATORY DIALYSIS 

-COPD

-ARDS

-Lung Trauma

-Pre & Post Anesthesia  in selected cases

-Chronic Bronchitis

-Congestive Heart Failure with pulmonary edema

-Neonatal Respiratory Distress Syndrome

COPD is predicted to be the third leading cause of death by 2020.Approximately 2.5 million people die yearly from acute exacerbations of the  respiratory diseases.

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Specimen collection in Infectious diseases

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Why specimen collection is Important in Microbiology

Specimen collection in Microbiology to isolate and identify the causative agents forms back bone of the investigative procedures.

In developing world, lack of awareness and casual attitude among junior staff hampers the definitive diagnosis.

Specific procedures in collecting specimens will certainly improve the quality of services of Microbiology Departments

Important questions before collecting a specimen

=Are you suspecting an Infection ?

    If so what is the Nature of infection, eg Bacterial,Viral, Mycological or

=Parasitological

=Which tests are your priority ?

=When to collect the specimen ?

=How to collect the specimen ?

=Am I choosing the correct container ?

=Why to send the specimens promptly

    if not what I should do ?

Tarot Suit of Wands

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Ace of Wands

-New Beginnings

 -Creative Energy

 -New Projects

 -New Career / Study

 -Birth

 -Optimism

-The Ace of Wands represents the powerful force of creative energy needed to launch new ideas, projects and ventures. 

-A symbol of newness, the drive needed to turn dreams into reality.

-Exciting possibilities emerge; there are feelings of optimism, confidence and ambition.

Two of Wands

==Vision and Expansion

 -Restlessness

 -Decisions and Plans

-The Two of Wands represents a time in life when initial stages of a project have taken shape but there is a desire for expansion and growth. 

-Often this desire is accompanied by a feeling of restlessness and a need to broaden ones horizons.

-The Two of Wands can also indicate partnerships. One could consult with a professional or expert regarding future plans.

Clinical approach to bleeding per rectum

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Clinical Approach 

-History

-Physical Examination

-Investigation

-Diagnosis

-Management

Lower Gastrointestinal Bleeding

-Lower GI bleeding originates in the portions of the GI tract below the Treitz ligament

-Hematochezia 90%

-Melena 10%

Blood transfusion

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-Transfusions of blood products can save lives, but are not without risks or costs

-Safe blood is a scarce and valuable resource that is expensive to collect, process and administer

-Limiting transfusion to patients whose chance of survival or quality of life is improved with blood will help to decrease the high demand for blood products and will reduce unnecessary exposure of patients to the risks of transfusion.

=Blood Safety

-Blood Safety Programme in India was initiated in 1989-90, which became an integral part of the National AIDS Control Program (NACP).WHO recommends that all donated blood should be tested for HIV/AIDS Besides, it is mandatory to test blood for hepatitis, syphilis, and malaria.

Hanta virus

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Hanta Viruses

Hanta virus belong to family  - Bunyaviridae Found Globally Causes serious diseases, can be fatal .It is estimated there are 100,000 to 200,000 infections occur worldwide.

Hanta Virus diseases

Hantavirus infections are caused by a group of viruses known as hantaviruses. These viruses cause two serious illnesses in humans. They are hemorrhagic (pronounced heh-meh-RA-jik) fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). 

Gas plasma sterilization

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GAS PLASMA

Gas Plasma (vaporized hydrogen peroxide) is a relatively new option that can provide low heat sterility cycles with none of the off-gassing concerns present with EtO. Gas Plasma (VHP) sterilization has, until now, been exclusively used by large manufacturers as the end line process for in-house sterilization. 

What is Gas Plasma

Plasma is a fourth state of matter which is distinguishable from liquid, solid, or gas. In nature, plasma is widespread in outer space. 

Gas plasma generated in an enclosed chamber under deep vacuum using Radio frequency or Microwave emery to excite gas molecules are produced charged particles

Community acquired pneumonias

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FRACTURE

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Definition of Fracture

Fracture: A fracture is a break in the continuity of the bone. 

Etiology

=Motor Vehicle Accident

=Fall

=Direct blow to the bone or an indirect force from muscle contraction

=Sports

=Vigorous Exercise

=Malnutrition

=Bone Diseases like Osteoporosis

Skeleton

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The Upper Limb

-The upper limb consists of the arm (brachium), forearm (antebrachium), and hand (manus)

-Thirty-seven bones form the skeletal framework of each upper limb

Arm

-The humerus is the sole bone of the arm

-It articulates with the scapula at the shoulder, and the radius and ulna at the elbow

===Major markings

=Proximal humerus includes the head, anatomical and surgical necks, greater and lesser tubercles, and the intertubercular groove

=Distal humerus includes the capitulum, trochlea, medial and lateral epicondyles, and the
=coronoid and olecranon fossae

Medial portion includes the radial groove and the deltoid process

Pseudomonas Septicemia

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Treatment & course during hospitalisation

Oral hygiene- chlorhexidine mouth wash

IV crystalloid –IVF NS & IP

        after hydration passed urine,relieving pain

        abdomen

IV antibiotics – started empiric treatment with 

                which further restricted to

                 inj.piperacilin tazobactum after blood c/s reporting

Patient received 1 unit of PRC & F.F.P.

Improved within 48 hrs –GCS 15/15

          fever severity decreased

          urine out put normal

          taking oral feeds

          no more pain abdomen 

Concurrent Nimotuzumab in Chemoradiation of Advanced Inoperable Head & Neck Cancer

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Introduction 

-Radiation therapy is the primary modality of treatment for loco-regionally advanced inoperable Head & Neck cancers. 

With Radiation therapy alone the rate of treatment failure is high, the overall cure rate and length of patient survival is lower. 

-New strategies have been continuously implemented : 

Use of concurrent chemotherapeutic drugs as radiation sensitizers has perhaps had the strongest impact on radiation therapy practice.

-Currently Biological response modifiers which enhance radiation and chemotherapy responses have been shown to further improve the therapeutic outcome of radiation therapy with acceptable morbidity.

CERVICAL SPONDYLOSIS SYNDROME

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Definition

Degeneration of cervical IVD and the secondary degeneration of cervical intervertebral joints, leads to injury of spinal cord, nerve roots and vertebral artery, and shows corresponding symptoms and signs

Causes

-Injury:   

     acute injury can further injure originally degenerative cervical vertebra and discs, this can induce cervical spondylosis.

 Chronic injury can speed up process of degeneration.

-Congenital deformity:

    stenosis of the cervical spinal canal.

Sterilization of operation theatres

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Greek Era

-Aristotle Greek Philosopher recommends 

   --Boiling water to   armies. Advises the Alexander.

   --Recommends hygiene for healthy living 

HAND WASHING- Semmelweis

Practices, emphasizes the importance of washing hands with chlorinated water in Obstetrics  to reduce maternal mortality

Surgical Neuropathology

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Important questions

-Age

-Location

-Clinical presentation

-Imaging

-Is this a new or recurrent lesion?

-Systemic infection or illness?

-Prior surgery, chemotherapy, and radiation?

-Has the patient been treated by steroid?

Neuropathology-Metabolic disorders

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Leukodystrophy

--Definition: 

It can manifests as leukoencephalomyelopathy, leukoencephalopathy, and leukomyelopathy.

Defective formation and maintenance of myelin. The white matter but not the gray matter is affected.

Leukodystrophies usually occur as hereditary diseases in infants and children. 

Some milder forms can have initial presentation can occur in adults.

--Etiology:

Storage disorder: peroxisomal and lysosomal, e.g., X-linked adrenoleukodystrophy, Krabbe disease.

Myelin formation: e.g., Pelizaeus-Merzbacher disease.

Others: e.g., Alexander’s disease, ataxia with vitamin E deficiency, subacute combined degeneration.

AED--Guide lines

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What is a seizure?

John Hughlings Jackson (North Yorkshire 1835 – London 1911)

Studying his wife (who had ‘Jacksonian’ seizures), he stated: 

“I have for more than ten years, and before the experiments of Hitzig and Ferrier were made, held that convolutions of the brain contain nervous arrangements representing movements. It is in accordance with this belief that I have long considered chorea, and more lately convulsion, to be movements resulting from 'discharges' of the cerebral cortex.” This results in “an occasional, an excessive and a disorderly discharge of nerve tissue of muscle.”

What is epilepsy?

ILAE:

A chronic neurological condition characterized:

-By recurrent epileptic seizures1 or by an enduring predisposition to generate epileptic seizures2 

-And by the neurobiologic, cognitive, psychological, and social consequences of this condition2

ADEM

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No accepted diagnostic criteria of ADEM.

Previously healthy child
With sudden onset.
Polysymptomatic onset of neurological deficit not correlated with anatomic location
Presumptive post infectious or vaccination process
With encephalopathy i.e
Behavioral change
Alteration of consciousness
No etiology can explain the events
Younger age.

MRI Finding

Some enlighted features of ADEM that are unsual in MS.
Absolute of Relative periventricular sparing
Lack of sharply defined borders of the lesion 

Asthma in children

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Objects:

To share the current concepts of guidelines for the management of asthma in children

Literature Review :

-US Expert Panel Report,NHBLI 2007
-Bangladesh National Guidelines on Bronchiolitis, COPD,Asthma,AAB 2005
-Indian National Asthma Guidelines,IAP 2003

Management of Bronchiectasis

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Mindfulness and Acceptance Therapy

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World TB day

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Peritoneum anatomy

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peritoneal dialysis

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Body Sculpting - Liposuction surgery Oklahoma city

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application of nanotechnology

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MANAGEMENT OF DIABETES – CARDIOLOGIST PERSPECTIVE TAKING DIABETES TO HEART

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Practical approach to a bleeding child

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Diastolic Dysfunction

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Very informative and educative ppt Which provide information about Diastolic Dysfunction . Slideworld.org provide educative and informative free medical powerpoint presentation. In this blog you can get free (PPT) Powerpoint on .