Islamic Teachings and Respiratory Medicine

Islamic Teachings

• Two phrases are easy to say but have immense value in the balance.
• These phrases are "سبحان الله وبحمده" (Subḥān Allāh wa bihamdih) and "سبحان الله العظيم" (Subḥān Allāh al-ʿazīm).
• These phrases are beloved by God.

Respiratory Medicine

• Respiratory Infections: This is a broad category of diseases affecting the respiratory system.

• Nosocomial Pneumonia: A type of pneumonia contracted in a hospital setting (often related to medical procedures), occurring 48+ hours post admission

• Pneumonia: An infection of the lungs, causing illness ranging from minor to severe, affecting people of varying ages.

• Causes of HAP/VAP:

  • Gram-negative bacteria (Pseudomonas, Escherichia, Klebsiella, Enterobacter, Acinetobacter)
  • Gram-positive cocci (Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, Streptococcus spp.)
  • Aerobic bacteria

• Risk factors:

  • Prior infection with Pseudomonas spp.
  • Pseudomonas spp. colonization
  • Very severe COPD
  • Bronchiectasis
  • Tracheostomy
  • Neutropenia
  • Burns
  • Cystic fibrosis

• Risk factors for MDR HAP/MRSA VAP/HAP/MDR Pseudomonas VAP/HAP: Prior IV antibiotic use within 90 days

• Types of HAP: Early-onset (diagnosed 2-5 days after hospitalization) and Late-onset (diagnosed >5 days after hospitalization)

• Pathophysiology: The processes involved in the development and progression of pneumonia include:

  • Hospital admission and presence of risk factors (e.g., prior antibiotic use)
  • Exposure to germs in the hospital environment
  • Changes in the normal oral/upper airway microbiome
  • Colonization with gram-negative Enterobacteriaceae and MRSA
  • Aspiration or inhalation of pathogens
  • Defective mucociliary and alveolar defenses
  • Macroaspiration in healthy patients or microaspiration in immunocompromised patients
  • Presence of viruses or bacteria

• Clinical Features:

  • Clinical: Fever (≥38°C), cough with purulent sputum
  • Radiographic: New or progressive infiltrates on chest X-ray
  • Lab: Leukocytosis or leukopenia

• Clinical Signs: Tachycardia, hypotension, tachypnea, hypoxia,r ales, wheezing, accessory respiratory muscle use, decreased/absent breath sounds, altered mental status, hypothermia

• Diagnosis: Physical examination, chest X-rays, chest CT, and laboratory tests.

• Differential Diagnoses: Pulmonary infarction, pulmonary/pleural tuberculosis, pulmonary edema, pulmonary eosinophilia, malignancy, cryptogenic organising pneumonia/bronchiolitis obliterans organising pneumonia

• Investigations: Blood cultures, sputum cultures, samples of lower respiratory tract secretion (endotracheal aspirate, BAL, and protected specimen brush sample), pleural aspirate

• Imaging techniques: Chest X-rays, Chest CT scans.

• Criteria for ICU Admission: (Major criteria) Invasive mechanical ventilation, septic shock with need for vasopressors; (Minor criteria) Confusion/disorientation, blood urea nitrogen ≥20mg/dL, respiratory rate ≥30breaths/min, hypotension requiring aggressive fluid resuscitation, PaO2/FiO2 ratio 250, multilobar infiltrates, WBC count <4000 cells/mm, platelet count ≤100,000 cells/mm, core temperature <36°C

• Management:
  -Monitor pulse, blood pressure, respiratory rate, temperature, oxygen saturation and mental status continually, especially important for patients with HAP or VAP.

  • Provide timely antibiotics
  • Recommend using PK/PD data for antibiotic dosing
  • Emphasize De-escalation as a principle of antimicrobial stewardship
  • Empiric antibiotics are dependent on individual risk factors

• Treatment Options:

  • Gram-positive coverage (e.g., vancomycin, linezolid)
  • Gram-negative coverage (e.g., piperacillin/tazobactam, cefepime, levofloxacin, imipenem/meropenem, ciprofloxacin)
  • Anaerobic coverage (e.g., clindamycin)