This document describes a case of dengue fever in a 36-year-old female patient who presented with high fever, body aches, headaches and joint pains for 4 days. Her lab tests showed low platelet count and hematocrit increase. She was diagnosed with dengue fever with warning signs and died within 24 hours of admission. It then provides details on the epidemiology, transmission, clinical presentation and management of dengue fever, noting it is a mosquito-borne illness caused by the dengue virus with nearly 400 million cases annually worldwide.
An acute fibrile illness syndrome caused by arboviruses that characterized by biphasic fever, myalgia, arthralgia, leukopenia, rash & lymphadenopathy.A.k.a dengue / breakbone fever
Only 1/3 of DHF patient develop shock and circulatory failure ( outpatient Tx is enough , bring back when there are alarming signs) .Early plasma, fluid & electrolyte replacement proved to have favourable outcome( maintain circulation). In DHF/DSS case, great care taken to reduce invasive procedures while managing shock
An acute fibrile illness syndrome caused by arboviruses that characterized by biphasic fever, myalgia, arthralgia, leukopenia, rash & lymphadenopathy.A.k.a dengue / breakbone fever
Only 1/3 of DHF patient develop shock and circulatory failure ( outpatient Tx is enough , bring back when there are alarming signs) .Early plasma, fluid & electrolyte replacement proved to have favourable outcome( maintain circulation). In DHF/DSS case, great care taken to reduce invasive procedures while managing shock
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
This ppt contains all information about epidemiology of Diptheria. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.
Pediatric dengue management - Dr. Arunkumar, MD(Paed)Arun Kumar
A presentation on clinical management of dengue fever and severe dengue in children.
By
Dr. Arunkumar. A, MD(Pediatrics)
consultant pediatrician,
KMCH Erode.
Now a days.All the World is facing a serious problem..Dengue
so i make a presentation on dengue to prevent and aware from dengue...and if you have dengue faver then which types of treatment you use for your Health.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
This ppt contains all information about epidemiology of Diptheria. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.
Pediatric dengue management - Dr. Arunkumar, MD(Paed)Arun Kumar
A presentation on clinical management of dengue fever and severe dengue in children.
By
Dr. Arunkumar. A, MD(Pediatrics)
consultant pediatrician,
KMCH Erode.
Now a days.All the World is facing a serious problem..Dengue
so i make a presentation on dengue to prevent and aware from dengue...and if you have dengue faver then which types of treatment you use for your Health.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Fazlina Binti Mohamed Yusoff, Family Medicine Specialist at Klinik Kesihatan (Health Clinic) Anika, Klang, Selangor, Malaysia.
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
My Presentation in College.
Hope its useful for you rather than sleeping in my desktop.
Sorry if there is any mistakes.
The presentation is about Dengue fever. First starting with the basic information like Introduction , Epidemiology ,Vector , Viral Morphology ,Mode of Transmission. Then little bit on Pathogenesis and Immune Response. Extra focus given to the Clinical Manifestations, symptoms and Lab Diagnosis with few simplified case studies. Control and prevention and treatment also included.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
1. DENGUE FEVER
Dr. Atta Ul Mohsin Cheema
Resident Emergency Medicine
POF Hospital Wah Cantt
2. Case Scenario
• 36 Year old female resident of Wah Cantt
• High grade fever 102-103 F
• Associated with body aches, headache, Joint pains for 4 days
• Decreased oral intake, vomiting, not tolerating oral fluids, pain
abdomen and gums bleed for 1 day.
• Past Medical & Surgical hx not significant.
6. Epidemiology
• Endemic in 128 countries
• 3.9 billion at risk of Dengue Fever
• 390 million cases annually
• 100 million present with clinical manifestations
• 5 million cases of Dengue Haemorrhagic fever
• 25,000 deaths annually worldwide
• First confirmed outbreak Pakistan-1994
• Since 2010- 16580 confirmed cases,257 deaths only in Lahore, and 5000
cases and 60 deaths from rest of country (WHO)
• Source: https://www.who.int/news-room/fact-sheets/detail/dengue-and-
severe-dengue
9. Dengue Epidemiology Report by NIH
https://www.nih.org.pk/wp-content/uploads/2019/09/36-FELTP-
Pakistan-Weekly-Epidemiological-Report-Sept-02-08-2019-.pdf
10. POF Hospital 2019
• Total no of suspected cases in POF Hospital: 204
• Dengue Serology : 1 +ve
• Dengue NS1 Antigen : 21 +ve
• Death : 1
11. Etiology
• Dengue Virus: Enveloped RNA virus
• Serotypes:DENV-1,DENV-2,DENV-3,DENV-4
• Homotypic immunity: Life long
• Heterotypic immunity: Short period
• Each serotype provide specific life long immunity and short term cross
immunity
12. Transmission
• Vector: Infected Female Aedes aegypti
• Carriers: Infected Humans
• Cycle: Mosquito-Human-Mosquito
• Incubation Period in humans: 4-10 days
• Viraemia period: 3-5 days,requires sufficient viral titers to infect
mosquitoes
• Incubation Period in mosquitoes: 8-12 days, then remain infected till
mosquitoes life
13. Transmission
• Vector: Aedes aegypti
• Pregnancy: A pregnant woman already infected with dengue can pass
the virus to her fetus during pregnancy or around the time of birth
• Breast Feeding: To date, there has been one documented report of
dengue spread through breast milk.
• Rare Routes: Rarely, dengue can be spread through blood transfusion,
organ transplant, or through a needle stick injury.
• Source: https://www.cdc.gov/dengue/transmission/index.html
• https://academic.oup.com/cid/article/57/3/415/460422#89056229
14. Facts
• These mosquitoes typically lay eggs near standing water in containers
that hold water, like buckets, bowls, animal dishes, flower pots, and
vases.
• These mosquitoes prefer to bite people, and live both indoors and
outdoors near people.
• Mosquitoes that spread dengue, chikungunya, and Zika bite during
the day and night.
• Mosquitoes become infected when they bite a person infected with
the virus. Infected mosquitoes can then spread the virus to other
people through bites.
17. Dengue Case Definitions 2015 NNDSS
• Suspected
• A clinically compatible case of dengue-like illness, dengue, or severe
dengue with an epidemiologic linkage.
• Probable
• A clinically compatible case of dengue-like illness, dengue, or severe
dengue with laboratory results indicative of probable infection.
• Confirmed
• A clinically compatible case of dengue-like illness, dengue, or severe
dengue with confirmatory laboratory results.
18. Clinical Features
•Warning Signs
•Abdominal pain or tenderness
•Persistent vomiting
•Extravascular fluid accumulation (e.g., pleural or
pericardial effusion, ascites)
•Mucosal bleeding at any site
•Liver enlargement >2 centimeters
•Increasing hematocrit concurrent with rapid decrease
in platelet count
31. Molecular test
• Nucleic Acid Amplification Test (NAAT)
• For symptomatic patients during the first 1-7 days of illness, any
serum sample should be tested with a NAAT and for IgM antibody
since both tests can be performed in serum. Performing both tests
can detect more cases than performing just one test.
• After day 7 of illness, few cases can be detected by NAAT.
32. Interpretation of results
• A positive NAAT result confirms dengue virus infection.
• A negative NAAT result does not rule out infection. People with NAAT
negative results should be tested for the presence of IgM antibodies
against dengue virus to determine possible recent dengue exposure.
• If both the NAAT and IgM antibody results from the acute phase of
illness are negative, a convalescent serum should be obtained for IgM
antibody testing.
• IgM laboratory unconfirmed case: If a patient with suspected dengue
virus infection submits an acute phase specimen that is negative (e.g.,
by NAAT and/or IgM antibody), and the patient does not submit a
convalescent specimen, the patient’s diagnosis is unconfirmed.
33. Dengue Virus Antigen Detection NS1
• NS1 is detectable during the acute phase of dengue virus infections.
NS1 tests can be as sensitive as molecular tests during the first 0-7
days of symptoms. After day 7, NS1 tests are not recommended.
• A positive NS1 test result confirms dengue virus infection without
providing serotype information.
• A negative NS1 test result does not rule out infection. People with
negative NS1 results should be tested for the presence of dengue IgM
antibodies to determine possible recent dengue exposure.
34. Serologic Tests
• Dengue virus-specific IgM and neutralizing antibodies typically
develop toward the end of the first week of illness. IgM levels are
variable, but generally are positive starting 4-5 days after onset of
symptoms and continuing for approximately 12 weeks post symptom
onset, but may persist longer.
35. Interpretation of results
• Positive IgM: Patients with a positive IgM test result are classified as
presumptive, recent dengue virus infections.
• Negative IgM:
• Patients with negative IgM results before day 8 of illness and absent or negative NAAT or NS1
results are considered unconfirmed cases. For these cases, a second sample should be
obtained after day 7 of symptoms for additional serologic testing.
• Patients with negative IgM results after 7 days of symptoms, and absent or negative NAAT or
NS1 (dengue virus antigen detection) are classified as negative for recent infection.
• Patients with a change from negative to positive IgM results in paired samples (first sample
collected during the first 7 days of illness, and second sample collected after symptoms
subside) are classified as current dengue infections.
• Due to cross-reaction with other flaviviruses and possible nonspecific reactivity,
results may be difficult to interpret. Consequently, presumed positive,
indeterminate, and equivocal, IgM antibody test results may be forwarded for
confirmation by plaque reduction neutralization testing (PRNT)
38. Case Management
• Group A- Dengue with out Warning Signs- Outdoor treatment
• Group B-Dengue with Warning Signs/Co Morbids- Indoor treatment
• Group C-Severe Dengue- Indoor treatment
39. Group A Management
• Can be sent home
• Tolerate oral fluids
• Absence of warning signs
• Oral rehydration therapy
• Adequate urine out put, once every 6 hour
• Oral Paracetamol every 6 hours
• Avoid Aspirin,NSAIDS.
• Advise when to visit ED
50. Prevention & Control
Vector control
Habitats reduction
Individual and house hold protection
Clothing
Repellants
Mosquito nets
Insecticides
Windows/door screens
51. Dengue Vaccine
• Age: 9-45 Years
• Confirmed Dengue Case
• Dosage: 3 doses.6 months apart.
• The vaccine manufacturer, Sanofi Pasteur, announced in 2017 that
people who receive the vaccine and have not been previously
infected with a dengue virus may be at risk of developing severe
dengue if they get dengue after being vaccinated.
