Dengue is a mosquito-borne viral disease that is widespread in tropical and subtropical regions. It affects nearly 100 million people annually. The disease is caused by the dengue virus, which has four serotypes. It is transmitted by the bite of infected Aedes mosquitoes. There is no vaccine available to prevent dengue. Treatment involves fluid replacement and pain management. Prevention focuses on reducing mosquito habitats and biting through the use of insect repellents, bed nets, and larviciding.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
Dengue fever is the fastest emerging arboviral infection spread
by Aedes mosquitoes with major public health consequences in
over 100 tropical and sub-tropical countries in South-East Asia,
the Western Pacific, and South and Central America. Up to 2.5
billion people globally live under the threat of dengue fever and its
severe forms—dengue hemorrhagic fever (DHF) or dengue shock
syndrome (DSS). More than 75% of these people, or approximately
1.8 billion, live in the Asia-Pacific Region. As the disease spreads to
new geographical areas, the frequency of the outbreaks is increasing
along with changing disease epidemiology. It is estimated that 50
a million cases of dengue fever occur worldwide annually and half a
million people suffering from DHF require hospitalization each year,
a very large proportion of whom (approximately 90%) are children
less than five years old. About 2.5% of those affected with dengue
die of the disease.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
Dengue fever is the fastest emerging arboviral infection spread
by Aedes mosquitoes with major public health consequences in
over 100 tropical and sub-tropical countries in South-East Asia,
the Western Pacific, and South and Central America. Up to 2.5
billion people globally live under the threat of dengue fever and its
severe forms—dengue hemorrhagic fever (DHF) or dengue shock
syndrome (DSS). More than 75% of these people, or approximately
1.8 billion, live in the Asia-Pacific Region. As the disease spreads to
new geographical areas, the frequency of the outbreaks is increasing
along with changing disease epidemiology. It is estimated that 50
a million cases of dengue fever occur worldwide annually and half a
million people suffering from DHF require hospitalization each year,
a very large proportion of whom (approximately 90%) are children
less than five years old. About 2.5% of those affected with dengue
die of the disease.
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Spreads by animals or insects
Requires a medical diagnosis
Lab tests or imaging often required
Short-term: resolves within days to weeks
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
Dengue a viral disease affecting millions worldwide is a vector borne disease.this ppt includes its etiology pathogenesis case management and epidemiology
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.
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
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
2. PROBLEM STATEMENT
Worldwide, annually in over 100 countries
99 million symptomatic dengue infections
404 million asymptomatic infections
500,000 cases of severe dengue
20,000 deaths.
The global burden of dengue has increased at
least fourfold over the last three decades.
There are now 2.5 billion people at risk of the
disease.
3.
4. Status In Nepal
The earliest cases were detected as early as
2005
Initially most of the reported cases had travel
history to neighbouring country (India).
Studies carried out in close collaboration of
WARUN/AFRIMS in the year 2006 by
EDCD/NPHL showed all 4 sub-types (DEN-1,
DEN-2, DEN-3 and DEN-4) of Dengue virus
circulation in Nepal.
Upto 2019, a total of 3425 confirmed dengue
cases were reported.
5.
6. AGENT FACTOR
Virus group: Flavivirus
Is a single-stranded enveloped RNA virus.
Four serotypes are known: DEN1, DEN2,
DEN3, DEN4
Principal Reservoir Host: Non human
primates
7. VECTOR
Different species of Aedes mosquitoes.
Aedes aegypti, Ae. albopictus, Ae.
Polynesiensis, Ae. scutellariscomplex.
Also known as Tiger Mosquito because of
stripped and branded nature of their leg.
Areas that are favourable for mosquito
breeding are household water storage like
bottles, buckets , pots, trees holes.
9. TRANSMISSION
The female mosquito bites humans during the
day.
After feeding the female Ae. aegypti can
transmit dengue immediately by a change of
host.
After an extrinsic incubation period of 8–10
days, during which time, the virus multiplies in
the salivary glands and which mosquito
becomes infective.
The mosquito host remains infective for life (30–
45 days).
10. ENVIRONMENTAL FACTORS
Survives around 16 to 30 degree celsius and
humidity of around 60-80 percent.
Outbreaks occurs around rainy season
because of pooling of household water.
11. PATHOPHYSIOLOGY
Major pathophysiologic changes that
determine the severity of disease in severe
dengue are plasma leakage and abnormal
hemostasis leading to rising hematocrit
values, moderate to marked
thrombocytopenia.
Sequential infection with any two of the four
serotypes of dengue virus results in severe
dengue infections in an endemic area.
12. PATHOPHYSIOLOGY ……
The residual antibodies produced during the
first infection are able to neutralize a second
viral infection with the same serotype.
However, when no neutralizing antibodies
are present (i.e. infection due to another
serotype of dengue virus), the second
infection is under the influence of enhancing
antibodies i.e increase their uptake by
cells, which express Fc. receptors on their
surfaces, like tissue dendritic cells, monocytes
and macrophages.
15. FEBRILE PHASE
Incubation period is around 2–7 days.
There is acute onset of fever with severe
headache, chills, pain behind the eyes,
particularly on eye movement, backache and
pain in the muscles, bones and joints( break
bone fever).
During the febrile period the temperature can be
as high as 40°C.
Fever is Continuous or ‘saddle-back’, with
break on 4th or 5th day and then
recrudescence; usually lasts 7–8 days.
16. Rashes
Initial flushing faint macular rash in first 1–2
days.
Maculopapular, scarlet morbilliform
blanching rash from days 3–5 on trunk,
spreading centrifugally and sparing palms
and soles; onset often with fever
defervescence.
May desquamate on resolution or give rise to
petechiae on extensor surfaces.
19. CRITICAL PHASE
The critical phase, which occurs at fever
defervescence usually around day 5.
This is peroid where an increase in capillary
permeability and plasma leakage can occur.
This may present clinically as pleural
effusions and ascites depending on the
degree of plasma leakage.
Once a critical volume is lost, shock ensues.
20. The pulse pressure becomes narrow (20
mmHg) with elevation of diastolic pressure to
meet the systolic pressure.
The platelet count drops shortly before or
simultaneously with the haematocrit rise
(20%) and both changes occur before the
subsidence of fever and before onset of shock.
Usually last for 24-48 hrs.
21. RECOVERY PHASE
The extravascular fluid begins to be resorbed
over the next 48–72 hours.
If intravenous fluids are continued into this
period there is significant risk of fluid overload,
manifesting as respiratory distress from pleural
effusions and/or ascites.
General symptomatic improvement is seen, with
return of appetite, haemodynamic stability and
diuresis. During this period, the white cell count
begins to rise followed by the platelets, the
haematocrit may drop.
24. WHO CLASSIFICATION
Dengue was previously classified (1997) into
dengue fever and dengue haemorrhagic fever
(DHF) of which there were four grades, with DHF
III and IV compiling dengue shock syndrome
(DSS).
In 2009, the WHO reclassified dengue due to
difficulty applying the old classification system in
clinical situations and increasing reports of severe
cases not fitting the criteria for DHF.
The new classification emphasizes levels of
severity with patients being classified as
dengue without warning signs
dengue with warning signs
and severe dengue.
25.
26.
27.
28.
29.
30. Tourniquet test
It is a clinical diagnostic method to determine
patients hemorrhagic tendency.
It assesses fragility of capillary walls and is
used to identify thrombocytopenia.
Used for diagnosis of dengue fever.
31. A blood pressure cuff is applied and inflated to
the midpoint between the systolic and
diastolic blood pressure for 5 minutes.
Test is positive if there are more than 10 to
20 petechiae per square inch.
33. Investigation
CBC reveals Leukopenia, thrombocytopenia
and raised hematocrit.
LFT may show elevations of serum
aminotransferase concentrations.
CXR and ultrasound shows pleural effusion (
common on rt side ) and ascitis respectively.
Stool occult blood test
Urine routine examination may show
hematuria.
36. NS1 antigen
The NS1 glycoprotein is produced by all
flaviviruses and is secreted from mammalian
cells.
NS1 is used to make an early diagnosis of
dengue virus infection.
Commercial kits for the detection of NS1
antigen are available, though they do not
differentiate between dengue serotypes.
ELISA based antigen detection test.
37.
38.
39. Differential Diagnosis
Hemorrhagic fevers
Influenza
Malaria
Enteric fever
Leptospirosis
Meningococcemia
Rickettsial infections.
Malaria, leptospirosis, flu and enteric fever
may also be coinfected with dengue.
40. Management
Dengue infection without warning signs.
May be treated symptomatically.
Fever and bodyaches are best treated with
paracetamol.
Salicylates and other nonsteroidal
antiinflammatory drugs should be avoided .
Plenty of fluids. There is no specific therapy.
Monitor the patient for warning signs along
with hematocrit and platelet counts.
41. Management
Dengue with warning signs
Require admission to the hospital
Need intravenous fluids, preferably
crystalloids
Frequent monitoring of hematocrit and vital
parameters.
42.
43. Severe dengue
hospitalized preferably in Intensive Care Unit
Treated with normal saline or lactated Ringer
solution.
10-20 ml/kg is infused over one hr or given as
a bolus if blood pressure is unrecordable.
44.
45. MANAGEMENT OF BLEEDING
Avoid IM injections.
There is no role of prophylactic platelet rich
plasma (PRP) infusions even with severe
thrombocytopenia. Avoid any procedures
predisposing .
Should be treated with blood transfusion if
required.
When bleeding cannot be managed with fresh
whole blood and there is possibility of DIC, fresh-
frozen plasma and platelet rich plasma may be
considered.
46. MANAGEMENT OF FLUID
OVERLOAD
Stop intravenous fluids but continue close
monitoring.
If necessary, give oral or intravenous
furosemide 0.1-0.5 mg/kg/dose once or twice
daily.
If patient is in critical phase, reduce the
intravenous fluid accordingly. Avoid
diuretics during the plasma leakagep hase
because they may lead to intravascular
volume depletion.
47. CONTROL MEASURES
Environmental control by source reduction
should be no opportunity for stagnation of
water in the bathroom, kitchen, terrace, lawn
and other open places. The stored water
should be kept covered.
Larval control by use of larvicides e.g paris
green, Mineral oils, chlorpyriphos.
Mesocyclops, the shellfish are credited to eat
and effectively eliminate larvae of Aedes
aegypti.
48. Anti adult measures like residual spray (e.g
DDT), space spray (e.g pyrethum).
Protection against the mosquito bite by using
mosquito nets, screening the building and
use of repellents.
49.
50.
51. Nine studies involving 34 248 participants were
included. The overall efficacy of CYD-TDV was 60%
(RR 0.40 (0.30 to 0.54)). Serotype-specific efficacy of
the vaccine was 51% for dengue virus type-1 (DENV-
1) (RR 0.49 (0.39 to 0.63)); 34% for DENV-2 (RR 0.66
(0.50 to 0.86)); 75% for DENV-3 (RR 0.25 (0.18 to
0.35)) and 77% for DENV-4 (RR 0.23 (0.15 to 0.34)).
Overall immunogenicity (MD) of CYD-TDV was
225.13 (190.34 to 259.93). Serotype-specific
immunogenicity was: DENV-1: 176.59 (123.36 to
229.83); DENV-2: 294.21 (181.98 to 406.45); DENV-3:
258.78 (146.72 to 370.84) and DENV-4: 189.35
(141.11 to 237.59). The most common adverse events
were headache and pain at the injection site.
52. TAKE HOME MESSAGES.
Potiential outbreak in Nepal in rainy season.
Secondary infection by another serotype can
result in severe Dengue.
Patient dies of shock not of bleeding.
Management is the FLUID, FLUID & FLUID.
No role of prophylactic platelet rich plasma
(PRP)
Always watch for the warning signs.
Source control best method for disease
outbreak control.
53. REFERENCES
HARRISONS PRINCIPLE OF INTERNAL
MEDICINE 20 EDITION
DAVIDSON’S PRINCIPLE AND PRACTICE
OF MEDICINE 23 EDITION
UPTODATE
WHO DENGUE GUIDELINE 2009