This clinical presentation discusses a case of dengue fever that developed into hemophagocytic lymphohistiocytosis (HLH). A 22-year-old male presented with high fever, body aches, and vomiting. He tested positive for dengue NS1 antigen. Over subsequent days, his condition worsened with the development of jaundice, pleural effusions, ascites, and altered mental status. Bone marrow biopsy showed features of reactive marrow with hyperplasia consistent with HLH. Treatment with dexamethasone led to rapid improvement, confirming the diagnosis of HLH secondary to severe dengue infection. The presentation emphasizes that dengue can rarely present as an "expanded dengue syndrome" with HLH and should
Anti-Phospholipid Syndrome Grand Round Presentation Dhaka Medical College Hos...Mohammed Shadman Shakib
A case of 20 year female presenting with fever, respiratory distress and joint pain.This case was presented in grand round session of Department of Medicine , Dhaka Medical College Hospital on 6th July, 2019.
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti-Phospholipid Syndrome Grand Round Presentation Dhaka Medical College Hos...Mohammed Shadman Shakib
A case of 20 year female presenting with fever, respiratory distress and joint pain.This case was presented in grand round session of Department of Medicine , Dhaka Medical College Hospital on 6th July, 2019.
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
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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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Presenting complaints
A 22-year-old male non-diabetic, normotensive
student hailing from Jagannath hall of DU, was
admitted under department of Internal Medicine on
31.10.21 with the complaints of
-Fever for three days
-Generalized body ache for same duration
-Nausea and vomiting for same duration
3. History of present illness
According to the patient’s statement, he was in his
usual state of health 3 days prior to admission,
then he developed fever. Fever was high grade,
highest recorded temperature 1040F, didn't
fluctuate more than 1°F and didn’t touch the
baseline. There was no H/O chills and rigor or
profuse sweating, not relieved by taking
paracetamol.
4. Patient had generalized body ache and joint pain
without any evidence of joint swelling and joint
tenderness. Patient complained of headache and
retro-orbital pain without altered level of consciousness
and convulsion. Patient also had nausea and vomiting
for same duration without abdominal pain. Vomiting
was non–projectile, contained undigested food
materials but not blood and bile stained.
5. There was no H/O cough, burning sensation during
micturition. Patient denied any H/O gum bleeding,
epistaxis, passage of blood with stool. As it was
endemic period for dengue on that time, patient did
dengue NS1 antigen test by himself and was found to
be positive. His bowel and bladder habit were normal.
13. Gastrointestinal system
• Lips, gums, teeth, tongue and oral cavity- Normal
• Abdomen:
• Inspection: Normal
• Palpation: Non tender in region
No palpable mass
No organomegaly
• Percussion: Tympanic, no shifting dullness
• Auscultation: Bowel sound- Normal
• DRE: Not done
14. Respiratory system
Inspection:
Shape of the chest: Normal
Palpation:
Trachea: Central in position
Apex beat: Left 5th intercostal space, 9cm from mid-sternal
line
Chest expansion- B/L symmetrical
Vocal fremitus: Normal
Percussion : Resonance
Auscultation:
Breath sound: Vesicular breath, no added sound
Vocal resonance: Normal
15. Cardiovascular system
Pulse: 110b/min, high volume, regular
Blood pressure: 110/70 mmHg( no postural drop)
JVP: Not raised
Precordium Examination:
Inspection: Normal
Palpation:
Apex beat in left 5th intercoastal space,9 cm from
midline
Palpable P2 and left parasternal heave-absent
Thrill-absent
Auscultation:1st and 2nd heart sound-audible, No
murmur
16. Nervous system
• Higher psychic function:
Conscious and oriented with normal speech.
• Cranial nerves: Intact
• Motor system:
Muscle tone: Normal
Muscle power: 5//5 on both upper & lower limb
(proximal and distal)
Reflexes: Normal
• Sensory system: Intact
• Cerebellar function and gait: Normal
• Fundoscopy: Normal
17. Salient features
A 22-year-old non-diabetic, normotensive Dhaka
University student was admitted under department of
Internal Medicine unit-2 with the complaints of high
grade, continued fever for 3 days, Highest recorded
temperature was 1040F along with nausea and
vomiting. Patient also had generalized body ache
,headache retro orbital pain and joint pain.
18. There was no H/O abdominal pain, hematemesis,
neck rigidity, altered level of consciousness,
convulsion, evidence of arthritis, cough, burning
sensation during micturition. Patient denied any H/O
gum bleeding, epistaxis, passage of blood with stool
and travelling to malaria endemic zone. He became
dengue NS1 antigen positive on his 3rd febrile period.
19. On general examination, patient was ill looking, diffuse
blanching maculo-papular rash over the trunk, pulse-
110b/min, temperature-102°F, respiratory rate-18
breaths/min, blood pressure-110/70mmHg,no postural
drop.
On systemic examination- no significant abnormality
was detected.
25. On 6th febrile period:
-Persistent high grade fever
-Shortness of breath
-Abdominal discomfort
O/E-
Jaundice- Present
Temperature-103°F
Tourniquet test- Positive
SPO2- 94 in room air
BP-110/80mmHg (lying position)
90/65mmHg (standing position)
features suggestive of B/L pleural effusion and
ascites
26. Date Hb
g/dl
HCT WBC/cmm PLT/cmm
3/11/2021 14.6 36.5 3800 39000
4/11/2021 14.8 38.1 4190 37000
5/11/2021 14.3 38.5 4280 36000
Date SGOT
U/L
SGPT
U/L
S. Bil
mg/dl
Total
protein
S.
Albumin
4/11/21 13189 2471 2.1
5/11/21 8485 1647 3.2 42.7 23.2
27. • PT with INR - 19.8 with 1.50 ( Prolonged)
• APTT - 48.5 sec (Prolonged)
• HBsAg - Negative
• Anti HCV - Negative
• Anti HEV IgM and IgG - Negative
• S. Electrolyte – Na- 128
K- 3.5
CL- 113
TCO2- 22
28. • Serum Creatinine - 0.9 mg/dl(N)
• Urine R/M/E – Normal
• ECG - Sinus Tachycardia
• Troponin - I - <0.002ng/ml(N)
• NT Pro BNP – 430 pg/ml(N)
• CRP- 63.4 mg/L
• Pro calcitonin- 9.7 ng/ml
• RT PCR for Covid 19- Negative
29.
30. • Chest X-ray A/P view - B/L pleural effusion
• USG of W/A - Mild to moderate ascites
B/L mild pleural effusion
• Blood for Culture- Sent
• Urine for Culture- Sent
31. On 5th November(on 8th febrile period)
Patient became drowsy, confused and disoriented
Temperature- 105°F
Pulse- 120 beats/min
BP- 90/60mmHg
GCS- 8/15
49. Investigation
• Bone marrow study- features suggestive
secondary reactive marrow with hyperplastic and
dysplastic changes in all three cell lineages.
• Fibrinogen level- 0.5g/L
• Serum LDH- 3406U/L
• Serum Triglyceride 278
52. Follow Up
• Fever subsided after 2 days
• Patient condition improved dramatically
• 1 week later we follow up patient where patient
condition was improved both clinically and
biochemically.
53. Date SGPT SGOT S. BILI ALBU
MIN
TP ALK
PHOS
15/11 114 134 1.9 32.3 61.2 152
DATE PROCA
L
D-
DIMER
16/11 2.8 11.84
54.
55. DISCUSSION REGARDING HLH:
- Rare, life-threatening disorder characterized by tissue
destruction due to abnormal immune activation.
- fever and multi-organ dysfunction, which is often
mistaken for sepsis.
- characterized by excessive macrophage activation
and cytokine release due to a failure in natural killer
cell function.
- Cause:Immune dysregulation and unchecked
inflammation.
57. Five of the following eight findings:
• Fever more than 38.5
• Splenomegaly
• PBF blood cytopenia, with at least two of the
following : HB < 9G/dL;platelet < 100000/
microl:absolute neutrophil count <1000/microL
• Hyper5triglyceridemia(fasting TG >265mg/dL) and/
or hypofibrinogenemia(<150mg/dl)
• Hemophagocytosis in bone marrow, spleen, lymph
node,or liver
• Low or absent nk cell activity
• Ferritin > 500ng/mL
• Elevated soluble CD25
58. • Example of others we would be likely to treat include
the following:
• A patient with CNS symptoms ,fever, cytopenias , and
ferritin >3000ng/ml or rapidly rising ferritin or elevated
sCD25
• A patient with CNS symptoms ,hepatitis, coagulopathy
and ferritin >3000ng/ml or rapidly rising ferritin or
elevated sCD25
• A patient with hypotension, fever, no response to broad
spectrum antibiotics and ferritin >3000ng/ml or rapidly
rising ferritin or elevated sCD25
59. 1.Approach varies depending upon trigger
2.Dexamethason
3.Etoposide
3.In mild cases associated with infection and
autoimmune disease-treat the underlying cause
4.Option for severe case-
Anakinra,IVIg,Rituximab,tacrolimus
5.+/- intrathecal methotrexate(CNS involvement)
6.In refractory case :Hemapoietic cell
transplantation.
Treatment of HLH:
60. Take home message
1.Dengue may present as various form such as
classical dengue, dengue haemorrhagic fever,
dengue shock syndrome, expanded dengue
syndrome.
2.When fever don’t subside with systemic
inflammatory response syndrome, we can suspect
expanded dengue syndrome with HLH.
3. Treatment with steroid shows dramatic response.
There is no significant past and personal history, family history, drug history
On general examination patient looked ill, temparature was 102 degree F, tachycardia and diffuse blanching maculopapular rash over the trunk was present. There is no postural hypotension, tourniquet test was negative
Patients all other systemic examination was unremarkable
During hospital course we did some investigation to monitor the patient whether it is DF or DHF
)
Daily we were monitoring the patients vitals, temperature chart, IO chart and biochemical parameter.
On 6th febrile period patient complaints of persistent high grade continued fever without chills and rigor which is not subsided rather increasing .fever associated with SOB, which was progressively increasing in nature , more on lying flat with no history of chest pain or cough. Patient also developed abdominal discomfort with dull aching diffuse abdominal pain
We closely observing the patient both clinically and biochemically. Here patients platelet count is downfalling and LFT was grossly altered. We send some investigation to search for other pathology.
PT APTT was prolonged, Hyponatrimia was present viral markers to check viral hepatitis which were negative
ECG shows only tachycardia, but his CRP and Pro cal was high. So send both blood and urine culture.
On his 8th febrile period when patient became drowsy and disoriented , GCS became 8/15 along his other parameter was deterioting he had high grade fever, tachycardia, hypotension,SOB, ascites. So we took consultation from critical care medicine,as both consultant aggred we shift patient as a case of Expanded dengu syndrom
In ICU patient initially treated with inj. Ceftriaxon and than switch to inj. Meropenem for persisting fever and rising inflammatory marker
In ICU patient develop AKI , LFT was still altered . He was treated with meropenem and other supportive treatment ,condition was gradually improving. But his fever did not subsided.
Due to his financial constrain he shifted to ward on his 12th febrile period.
We looked for sign. of meningeal irritation
A medical board was arranged on 11th November and decision was taken for therapeutic paracentesis and add antibiotic and repeat inflammatory marker
Repeat Xray
Depending on this clinical and biochemical senerion what may be the causes