This document provides information on recognizing and managing dengue infections. It discusses the pathogenesis, clinical course, diagnosis and differential diagnosis of dengue. The clinical course is divided into the febrile, critical and recovery phases. Classification of dengue cases and recommendations for clinical management are also provided, including fluid management and treatment for different severity groups (A, B and C). Group C requires emergency treatment for severe manifestations like shock. Overall the document aims to guide healthcare professionals in appropriately diagnosing and treating dengue infections.
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.
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.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
Dengue is a self limited acute febrile condition and sometimes
haemorrhagic, primarily transmitted to the humans from
infected Aedes species ( Ae. aegypti or Ae. albopictus ).
Dengue Syndrome will be discussed in following headings
1.Epidemiology
2. Manifestation
3. Clinical presentation,
4. Diagnosis
5. Treatment
6. Prevention & Control
It is about detailed management of dengue and malaria in adults and children with brief review of clinical history and diagnosis.
reference:
-latest WHO and CDC guidelines
-Nelson 21st edition
-Ghai-Essential Paediatrics 9th edition
-Harrison
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 Yasmin Mohamed Gani, Infectious Disease Physician at Hospital Sungai Buloh, Malaysia.
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
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 Nik Khairulddin Nik Yusoff, Consultant Paediatrician (Infectious Diseases) at Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
Dengue is a self limited acute febrile condition and sometimes
haemorrhagic, primarily transmitted to the humans from
infected Aedes species ( Ae. aegypti or Ae. albopictus ).
Dengue Syndrome will be discussed in following headings
1.Epidemiology
2. Manifestation
3. Clinical presentation,
4. Diagnosis
5. Treatment
6. Prevention & Control
It is about detailed management of dengue and malaria in adults and children with brief review of clinical history and diagnosis.
reference:
-latest WHO and CDC guidelines
-Nelson 21st edition
-Ghai-Essential Paediatrics 9th edition
-Harrison
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 Yasmin Mohamed Gani, Infectious Disease Physician at Hospital Sungai Buloh, Malaysia.
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
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 Nik Khairulddin Nik Yusoff, Consultant Paediatrician (Infectious Diseases) at Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
Fluid Management of Dengue Patients According to National Guideline 2019 Lisanul Hasan
This is a working protocol of fluid management of dengue patients based on the national guideline of Bangladesh in 2019. I prepared and presented this working protocol for the doctors of medicine unit 9 of Dhaka Medical College & Hospital and it was widely used during the Dhaka Dengue Epidemic 2019.
Based on the current NACO guidelines for prevention of parent to child transmission of HIV in India. Also describes the medication, testing and followup of children born to HIV positive mothers.
The commonly used oxygen delivery systems available for use in children/adults are described with pictures. Indications and side effects of oxygen therapy are also outlined.
Acute respiratory infection in children, etiology, clinical features, diagnosis, treatment. Common infections in children including common cold, tonsillitis, LTB, Croup, Epiglottitis etc.
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
2. Introduction
• Dengue is a self limiting acute mosquito transmitted disease.
• Characterized by fever , headache, muscle, joint pains, rash, nausea and
vomiting.
• Caused by an arbovirus and spread by Aedes mosquitoes.
• Four serotypes i.e. Dengue 1,2,3 and 4. DEN1 and DEN2 serotypes most
prevalent in India.
• Season- July to Nov .
3.
4. Immuno- Pathogenesis
• Primary or first infection in non immune persons usually causes Dengue
fever.
• Subsequent dengue infection by different serotype causes more severe
illness like DHF/DSS.
• Major pathophysiologic changes-
Plasma leakage
Rising Hematocrit
Thrombocytopenia
Bleeding manifestations
5.
6. Course of dengue illness
• Incubation period 4 – 10 days.
• Classic presentation seen in older children, adolescents and adults.
• Described under three phases-
1. Febrile phase
2. Critical phase
3. Recovery phase
7. 1. Febrile Phase
• Patients typically develop a high-grade fever suddenly.
• Febrile phase lasts 2−7 days.
• Often accompanied by facial flushing, skin erythema, generalized body ache,
myalgia, arthralgia, retro-orbital eye pain, photophobia, rubeliform exanthema
and headache .
• Positive tourniquet test.
• Minor bleeding manifestations.
• Decrease in Platelets andTLC.
8. Tourniquet test : Performed by inflating a blood pressure cuff to a mid point
between the systolic and diastolic pressure for five minutes. The test is
considered positive when 10 or more petechiae per 2.5 cm sq are observed. In
DHF , the test usually gives a definite positive test with 20 petechiae or
more. The test may be negative or only mildly positive during the phase of
profound shock (DSS).
9. 2. Critical Phase
• From 3 – 7 days of onset.
• Some will improve without going
through the critical phase.
• Patients with increased capillary
permeability may manifest with the
warning signs.
• They will usually recover with
intravenous rehydration.
• Some cases will deteriorate to severe
dengue
Warning Signs
• Clinical Abdominal pain or tenderness
• Persistent vomiting
• Lethargy, restlessness
• Mucosal bleed
• Liver enlargement > 2cm or tender enlarged
liver
• Clinical fluid accumulation
• Increase in haematocrit level concurrent with
rapid decrease in platelet count
10. 3. Recovery Phase
• After 24-48 hrs in critical phase, gradually reabsorption of extravascular fluid
takes place in 48-72 hrs.
• General well-being improves, appetite returns, gastrointestinal symptoms
abate, haemodynamic status stabilizes, and diuresis ensues.
• A rash of ‘isles of white in sea of red’ may appear.
• PCV stabilizes andTLC starts to rise.
• Recovery of platelet counts takes longer.
11.
12. Dengue case classification
• Revised classification (2009 )
1.Dengue Infection without warning signs.
2.Dengue with warning signs.
3.Severe Dengue.
13.
14. Differential Diagnosis
Conditions that mimic the febrile phase of dengue infection
• Flu-like syndromes - Influenza, measles, chikungunya, infectious
mononucleosis, HIV-seroconversion illness
• Illnesses with a rash - Rubella, measles, scarlet fever, meningococcal infection,
chikungunya, drug reactions.
• Diarrhoeal diseases - Rotavirus, other enteric infections.
• Illnesses with neurological manifestations - Meningoencephalitis, Febrile
seizures
15. Conditions that mimic the critical phase of dengue infection
• Infectious - Acute gastroenteritis, malaria, leptospirosis, typhoid, typhus,
viral hepatitis, Acute HIV-seroconversion illness, bacterial sepsis, septic
shock
• Malignancies - Acute leukaemia and other malignancies
• Other clinical pictures - eg. Acute abdomen, Diabetic ketoacidosis,
Kawasaki syndrome, Platelet disorders, Systemic lupus erythematosus etc.
18. Recommendations for clinical management
• A stepwise approach to the management of dengue
1. Step I – Overall assessment
2. Step II – Diagnosis, assessment of disease phase and severity
3. Step III – Disease notification and management decision (Groups A–C)
19. Step I – Overall assessment
The history should include-
• Date of onset of fever/illness
• Quantity of oral fluid intake
• Diarrhoea
• Urine output (frequency, volume and time of last voiding)
• Assessment of warning signs
• Change in mental state/seizure/dizziness
20. The physical examination should include-
• Assessment of mental state
• Assessment of hydration status
• Assessment of haemodynamic status
• Checking for quiet tachypnoea/acidotic breathing/pleural effusion
• Checking for abdominal tenderness/hepatomegaly/ascites
• Examination for rash and bleeding manifestations
• Tourniquet test (repeat if previously negative or if there is no bleeding
manifestation).
21. Step II – Diagnosis, assessment of disease phase and severity
• Determine whether the disease is dengue ?
• Which phase it is in (febrile, critical or recovery) ?
• Are there warning signs ?
• What is the hydration status ?
• Haemodynamic state of the patient, and whether the patient requires
admission ?
22. Step III – Disease notification and management decision (Groups A–C)
• Depending on the clinical manifestations and other circumstances, patients
may either be :
1. (Group A) –Can be sent home
2. (Group B) - Referred for in-hospital management
3. (Group C) - Require emergency treatment and urgent referral
23. Treatment according to Groups A–C
1. Group A
• Able to tolerate adequate volumes of oral fluids.
• Pass urine at least once every six hours.
• Do not have any of the warning signs (particularly when fever subsides).
Commercial carbonated drinks that exceed the isotonic level (5% sugar) should
be avoided.
Give Paracetamol for high fever.The recommended dose is 10 mg/kg/dose.
24. If any of following is observed, the patient should be immediately taken to
the nearest hospital -
• Bleeding:
− red spots or patches on the skin − black-coloured stools
− bleeding from nose or gums − heavy menstruation/vaginal bleed
− vomiting blood
• Frequent vomiting or not able to drink
• Severe abdominal pain
• Drowsiness, mental confusion or seizures
• Pale, cold or clammy hands and feet
• Difficulty in breathing
• Postural dizziness
• No urine output for 4–6 hours
25. 2. Group B
• Patients with warning signs.
• Co-existing conditions (such as pregnancy, infancy, old age, obesity,
diabetes mellitus, hypertension, heart failure, renal failure, chronic
haemolytic diseases such as sickle-cell disease and autoimmune diseases).
WARNING SIGNS
Clinical Abdominal pain or tenderness
Persistent vomiting
Lethargy, restlessness
Mucosal bleed
Liver enlargement > 2cm or tender enlarged liver
Clinical fluid accumulation
Increase in haematocrit level concurrent with rapid decrease in platelet count.
26. Management of Group B patients
• Rapid fluid replacement in patients with warning signs is the key to prevent
progression to the shock state.
• Obtain a reference haematocrit before starting IVF.
• Give only isotonic solutions such as 0.9% saline / RL.
• Normal maintenance fluid per hour is calculated as :
o 4 ml/kg/hr for first 10 kg body weight
o + 2 ml/kg/hr for next 10 kg body weight
o + 1 ml/kg/hr for subsequent kg body weight
27. • If the vital signs are worsening and the haematocrit is rising rapidly, increase
the rate to 5−10 ml/kg/hour for 1−2 hours.
• Intravenous fluids are usually needed for only 24−48 hours.
• Monitor for –
Vitals
Peripheral perfusion
Urine output (4-6 hrly)
Hematocrit ( before & after fluid replacement then 6-12 hrly)
Blood Glucose
Other organ functions - RFT, LFT, Coagulation profile
28. 3. Group C
They are in the critical phase of the disease and have:
I. Severe plasma leakage leading to dengue shock and/or fluid accumulation
with respiratory distress.
II. Severe haemorrhages.
III. Severe organ impairment (hepatic damage, renal impairment,
cardiomyopathy, encephalopathy or encephalitis).
29. Management of Group C patients
1) Management of shock
2) Treatment of haemorrhagic complications
3) Glucose control
4) Electrolyte and acid-base imbalances
5) Metabolic acidosis
30. 1) Management of shock
• Compensated shock (Systolic pressure maintained + signs of reduced perfusion)
• Profound shock (hypotensive; undetectable pulse and BP)
The goals of fluid resuscitation include:
• Improving central and peripheral circulation – i.e. decreasing tachycardia, improving BP
and pulse volume, warm and pink extremities, a capillary refill time < 2 seconds
• Improving end-organ perfusion – i.e. achieving a stable conscious level (more alert or
less restless), and urine output ≥ 0.5 ml/kg/hour or decreasing metabolic acidosis.
31.
32.
33. 2) Treatment of haemorrhagic complications
• Mucosal bleeding may occur & is usually minor.
• If major bleeding occurs it is usually from the G.I tract, and/or hypermenorrhoea.
• Fresh whole blood or fresh PRBC should be given. Stored erythrocytes lose 2,3
DPG, low levels of which impede the oxygen-releasing capacity of haemoglobin.
• No evidence to support the practice of transfusing platelet concentrates and/or
fresh-frozen plasma for severe bleeding in dengue.
• H-2 antagonist and PPIs have been used, but their efficacy is not clear.
• Great care should be taken when inserting a nasogastric tube or bladder
catheters which may cause severe haemorrhage.
34. 3) Glucose control
• Hyperglycemia
o Occurs due to neuroendocrine stress response or from glucose containing fluids
used in resuscitation.
o Causes osmotic diuresis which worsens the hypovolaemic shock.
oMost cases of hyperglycaemia will resolve with appropriate (isotonic, non-
glucose) and adequate fluid resuscitation.
o If persistent, intravenous insulin therapy can be initiated. Subcutaneous insulin
should be avoided as absorption is unreliable in the shock state .
35. • Hypoglycemia
oStarvation in young children or severe liver involvement can cause
hypoglycaemia.
oHypoglycaemia should be treated as an emergency with 0.1−0.5 g/kg of
glucose i.e 1 – 5 ml/kg of D-10.
o Euglycaemia should then be maintained with a fixed rate of glucose-
isotonic solution and enteral feeding if possible.
oMonitor Glucose frequently.
36. 4) Electrolyte and acid-base imbalances
• Hyponatraemia –
Can be due to G.I losses through vomiting and diarrhoea or the use of
hypotonic solutions for resuscitation and correction of dehydration.
The use of isotonic solutions for resuscitation will prevent and correct this
condition.
37. • Hyperkalaemia –
Is observed in association with severe metabolic acidosis or acute renal injury.
Appropriate volume resuscitation will reverse the metabolic acidosis and the
associated hyperkalaemia.
If life threatening should be controlled with Resonium A and infusions of
calcium gluconate and/or insulin-dextrose. Renal support therapy may have to
be considered.
38. • Hypokalaemia –
Often associated with G.I fluid losses and the stress-induced hypercortisol state.
Should be corrected with potassium supplements in the parenteral fluids.
• Calcium-
Serum calcium levels should be monitored and corrected when large quantities
of blood have been transfused or if sodium bicarbonate has been used.
39. 5) Metabolic acidosis
• Compensated metabolic acidosis is an early sign of hypovolaemia and shock.
• Lactic acidosis-
Caused by tissue hypoxia and hypoperfusion & is the most common cause of
metabolic acidosis in dengue shock
Correction of shock and adequate fluid replacement will correct the metabolic
acidosis.
If remains uncorrected, one should suspect severe bleeding and check the
haematocrit.Transfuse fresh whole blood or fresh packed red cells urgently.
40. Sodium bicarbonate for metabolic acidosis caused by tissue hypoxia is not
recommended for pH ≥ 7.10.
Bicarbonate can lead to sodium and fluid overload, an increase in lactate and
pCO2 and a decrease in ionized calcium. A left shift in the oxy– haemoglobin
dissociation curve may aggravate the tissue hypoxia.
• Hyperchloraemic acidosis-
Caused by the administration of large volumes of 0.9% sodium chloride
solution (Cl of 154 mmol/L).
If serum chloride levels increase, use Ringer’s lactate as crystalloid.
41. Discharge Criteria
All of the following conditions must be present:
• Clinical
No fever for 48 hours
Improvement in clinical status (general well-being, appetite, haemodynamic
status, urine output, no respiratory distress)
• Laboratory
Increasing trend of platelet count
Stable haematocrit without intravenous fluids