A VERYGOOD PRESENTATION FOR MEDICAL STUDENTS.
ALL THE TOPICS ABOUT
VECTOR
VIRUS
PATHOGENESIS
PATHOPHYSIOLOGY
CLINICAL CLASSIFICATION - NEW
CLINICAL COURSES - 3 PHASES
INVESTIGATIONS
STEPWISE MANAGEMENT
CLINICAL CASE STUDY
This document summarizes the 2021 guidelines for management of sepsis and septic shock from the Surviving Sepsis Campaign. It discusses updates to screening and resuscitation recommendations including using lactate clearance and capillary refill time to guide resuscitation. It also covers antimicrobial timing and stopping rules, use of balanced crystalloids for fluid resuscitation, initiating vasopressors peripherally, and considering veno-venous ECMO for severe ARDS. The role of steroids and IV vitamin C in septic shock are also briefly mentioned.
Intracranial pressure - waveforms and monitoringjoemdas
The document discusses intracranial pressure (ICP) waveforms and monitoring. It defines the components of the intracranial vault and describes the normal ICP waveform consisting of P1, P2, and P3 waves representing arterial pulsation, intracranial compliance, and venous pulsation, respectively. It also discusses Lundberg waves including A waves resulting from increased cerebrovascular volume due to vasodilation, B waves related to respiratory fluctuations in PaCO2, and C waves corresponding to Traube-Hering-Meyer fluctuations. The gold standard for ICP monitoring is external ventricular drainage connected to an external strain gauge, which allows CSF drainage but carries risks of infection and hemorrhage. Int
This document provides an overview of Moyamoya disease. It defines Moyamoya disease as a progressive stenosis of the intracranial arteries, typically the internal carotid arteries and proximal middle and anterior cerebral arteries, accompanied by a compensatory network of collaterals at the brain's base. The cause is unknown but genetic factors are believed to play a role. Clinically, it can present with transient ischemic attacks, strokes, or hemorrhage. Diagnosis is based on neuroimaging findings on MRI, MRA, CTA or DSA showing the characteristic vascular changes. Treatment involves medical management as well as surgical revascularization procedures. Prognosis depends on the extent of vascular involvement and collateral formation.
This document provides an overview of meningitis and encephalitis. It discusses the different types of bacterial, viral and fungal meningitis including their causes, symptoms, diagnosis and treatment. Key points include that bacterial meningitis can be caused by organisms like pneumococcus, meningococcus and haemophilus influenza. Viral meningitis causes aseptic meningitis while encephalitis involves brain inflammation. Diagnosis involves lumbar puncture and CSF analysis. Treatment depends on the identified organism and may involve antibiotics, antivirals or antifungals.
AKI is a common problem in ICU patients, occurring in up to 18% of hospitalized patients with normal kidney function. Risk factors include conditions that reduce blood flow to the kidneys like sepsis or hypotension. The kidneys are vulnerable to toxins and drugs due to their high blood flow and the tubules' role in reabsorbing and secreting materials. Early detection of AKI using markers like serum creatinine and urine output is important for management, which aims to treat the underlying cause, ensure proper fluid balance and nutrition, and consider renal replacement therapy for severe cases.
Neuromonitoring and Cerebral Protection Strategiesanaest_husm
This document discusses neuromonitoring and cerebral protection strategies for patients with brain injuries. It covers the physiology of the central nervous system, intracranial pressure monitoring, pathophysiology of brain injury, and various methods of central nervous system monitoring including intracranial pressure, brain oxygenation, metabolism, hemodynamics, and electrical activity. Continuous monitoring can help detect secondary insults like hypoxia and ischemia early to guide treatment and minimize further brain damage.
1. The document discusses various neurological emergencies including coma, seizures, syncope, and stroke. It provides guidance on assessing and managing the airway, breathing, and circulation for patients with an altered mental status.
2. For seizures, it describes different seizure types and emphasizes protecting the patient during a seizure and assessing them afterwards.
3. Syncope or fainting is discussed as a temporary loss of consciousness often due to low blood pressure or cardiac issues. Stroke signs like paralysis and speech problems are also outlined.
This document summarizes definitions and guidelines for the diagnosis and management of sepsis. It defines sepsis as a clinical syndrome resulting from infection along with systemic inflammatory response syndrome (SIRS). The onset of sepsis focuses on dysregulation of inflammation and can lead to multiple organ dysfunction syndrome (MODS) and high mortality. Diagnostic criteria for sepsis require confirmed or suspected infection along with general, inflammatory, hemodynamic, or organ dysfunction variables. Management of severe sepsis and septic shock prioritizes early supportive care to correct hypoxemia and hypotension, rapid fluid resuscitation, vasopressors if hypotension persists, and control of the septic focus. Early goal-directed resuscitation aims to optimize perfusion parameters like mean
This document summarizes the 2021 guidelines for management of sepsis and septic shock from the Surviving Sepsis Campaign. It discusses updates to screening and resuscitation recommendations including using lactate clearance and capillary refill time to guide resuscitation. It also covers antimicrobial timing and stopping rules, use of balanced crystalloids for fluid resuscitation, initiating vasopressors peripherally, and considering veno-venous ECMO for severe ARDS. The role of steroids and IV vitamin C in septic shock are also briefly mentioned.
Intracranial pressure - waveforms and monitoringjoemdas
The document discusses intracranial pressure (ICP) waveforms and monitoring. It defines the components of the intracranial vault and describes the normal ICP waveform consisting of P1, P2, and P3 waves representing arterial pulsation, intracranial compliance, and venous pulsation, respectively. It also discusses Lundberg waves including A waves resulting from increased cerebrovascular volume due to vasodilation, B waves related to respiratory fluctuations in PaCO2, and C waves corresponding to Traube-Hering-Meyer fluctuations. The gold standard for ICP monitoring is external ventricular drainage connected to an external strain gauge, which allows CSF drainage but carries risks of infection and hemorrhage. Int
This document provides an overview of Moyamoya disease. It defines Moyamoya disease as a progressive stenosis of the intracranial arteries, typically the internal carotid arteries and proximal middle and anterior cerebral arteries, accompanied by a compensatory network of collaterals at the brain's base. The cause is unknown but genetic factors are believed to play a role. Clinically, it can present with transient ischemic attacks, strokes, or hemorrhage. Diagnosis is based on neuroimaging findings on MRI, MRA, CTA or DSA showing the characteristic vascular changes. Treatment involves medical management as well as surgical revascularization procedures. Prognosis depends on the extent of vascular involvement and collateral formation.
This document provides an overview of meningitis and encephalitis. It discusses the different types of bacterial, viral and fungal meningitis including their causes, symptoms, diagnosis and treatment. Key points include that bacterial meningitis can be caused by organisms like pneumococcus, meningococcus and haemophilus influenza. Viral meningitis causes aseptic meningitis while encephalitis involves brain inflammation. Diagnosis involves lumbar puncture and CSF analysis. Treatment depends on the identified organism and may involve antibiotics, antivirals or antifungals.
AKI is a common problem in ICU patients, occurring in up to 18% of hospitalized patients with normal kidney function. Risk factors include conditions that reduce blood flow to the kidneys like sepsis or hypotension. The kidneys are vulnerable to toxins and drugs due to their high blood flow and the tubules' role in reabsorbing and secreting materials. Early detection of AKI using markers like serum creatinine and urine output is important for management, which aims to treat the underlying cause, ensure proper fluid balance and nutrition, and consider renal replacement therapy for severe cases.
Neuromonitoring and Cerebral Protection Strategiesanaest_husm
This document discusses neuromonitoring and cerebral protection strategies for patients with brain injuries. It covers the physiology of the central nervous system, intracranial pressure monitoring, pathophysiology of brain injury, and various methods of central nervous system monitoring including intracranial pressure, brain oxygenation, metabolism, hemodynamics, and electrical activity. Continuous monitoring can help detect secondary insults like hypoxia and ischemia early to guide treatment and minimize further brain damage.
1. The document discusses various neurological emergencies including coma, seizures, syncope, and stroke. It provides guidance on assessing and managing the airway, breathing, and circulation for patients with an altered mental status.
2. For seizures, it describes different seizure types and emphasizes protecting the patient during a seizure and assessing them afterwards.
3. Syncope or fainting is discussed as a temporary loss of consciousness often due to low blood pressure or cardiac issues. Stroke signs like paralysis and speech problems are also outlined.
This document summarizes definitions and guidelines for the diagnosis and management of sepsis. It defines sepsis as a clinical syndrome resulting from infection along with systemic inflammatory response syndrome (SIRS). The onset of sepsis focuses on dysregulation of inflammation and can lead to multiple organ dysfunction syndrome (MODS) and high mortality. Diagnostic criteria for sepsis require confirmed or suspected infection along with general, inflammatory, hemodynamic, or organ dysfunction variables. Management of severe sepsis and septic shock prioritizes early supportive care to correct hypoxemia and hypotension, rapid fluid resuscitation, vasopressors if hypotension persists, and control of the septic focus. Early goal-directed resuscitation aims to optimize perfusion parameters like mean
I worked on this presentation in 2017, for the Infectious disease department. My sources are: UpToDate, IDSA guidelines. Please share & give me credit to my work.
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major healthcare problem with high mortality rates, especially septic shock which has mortality rates of 50-60%.
2) The new Sepsis-3 definition defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection represented by an increase of two or more points in the SOFA score.
3) Early goal-directed therapy (EGDT) is a protocol-based approach for initial resuscitation of sepsis patients. It aims to achieve specific goals for central venous pressure, mean arterial pressure, ScvO2, and other parameters within 6 hours and
1. Status epilepticus is a medical emergency characterized by prolonged seizures without recovery between seizures or continuous seizure activity lasting more than 30 minutes.
2. It can be caused by not taking anti-seizure medications, infections, brain tumors, head trauma, or other underlying medical conditions.
3. Nursing care focuses on preventing injury during seizures, reducing fears and improving coping, providing education to patients and families, and monitoring for complications of prolonged seizure activity and medication side effects.
This document discusses catheter-related bloodstream infections (CRBSIs). It defines CRBSIs and describes different catheter types. CRBSIs are caused by pathogens migrating from the skin insertion site into the catheter or through direct contact. Common pathogens include staphylococci and candida. The document recommends a bundle of strategies to prevent CRBSIs, including education and training, maximal sterile barrier precautions, chlorhexidine skin antisepsis, securement devices, and antimicrobial catheters when infection rates remain high despite other measures. Regular assessment and performance improvement initiatives can help increase adherence to guidelines.
1. The document discusses intracranial pressure (ICP), cerebrospinal fluid (CSF) circulation and compensation mechanisms when ICP increases. It defines normal ICP and the factors that affect it, including the Monro-Kellie doctrine.
2. Symptoms of increased ICP are described, from early signs like headache to late signs like herniation and changes in vital signs. Different types of herniation are explained.
3. Methods for monitoring ICP are summarized, including invasive techniques like intraventricular and subdural monitors and non-invasive options. Indications for ICP monitoring include severe head injuries with abnormal CT scans or certain risk factors.
This document discusses cerebral edema, which occurs when excess fluid accumulates in the brain tissue leading to increased intracranial pressure. It classifies edema into cytotoxic, vasogenic, and interstitial types based on etiology. Cytotoxic edema results from cellular damage while vasogenic edema stems from blood-brain barrier disruption. Managing cerebral edema focuses on optimizing ventilation, intravenous fluids, blood pressure control, and using osmotherapy agents like mannitol to reduce brain water content.
Surg351 presentation and management of raised intracranial pressureepididymis
This document discusses raised intracranial pressure (ICP), including normal ICP, causes of increased ICP, clinical signs and symptoms, investigations, general treatment measures, and specific treatments for different causes. The normal ICP is around 10 mmHg, and ICP above 20 mmHg is considered pathological. Increased ICP can be caused by factors that increase the volume of brain, blood, or cerebrospinal fluid such as cerebral edema, hydrocephalus, or vascular dilation. Space-occupying lesions like tumors or abscesses can also cause elevated ICP. The general treatment approach involves measures to reduce ICP like head elevation, diuretics, hyperventilation, and sedation, as well as definitive treatments
Early onset of neonatal group b streptococcus diseases zharifDr Zharifhussein
- The document discusses Group B Streptococcus (GBS), a bacteria that can cause infections in newborn babies and other high-risk groups.
- GBS often colonizes the intestines or vagina without causing symptoms. It can be passed from mother to baby during childbirth and cause early or late-onset infections.
- Early-onset GBS infections usually occur within the first week of life and often present as sepsis, pneumonia, or meningitis. Late-onset infections typically occur between 1 week and 3 months of age and usually manifest as meningitis or sepsis.
- Guidelines recommend identifying high-risk mothers through GBS screening or risk factors like previous GBS-infected baby, G
The document discusses intracranial pressure (ICP), providing definitions and normal values. It describes cerebrospinal fluid (CSF) and autoregulation of cerebral blood flow. It covers evaluation of raised ICP including Monro-Kellie doctrine, Cushing's triad, and changes in the cranium. It discusses types of cerebral edema and causes of raised ICP. Clinical features, investigations, and general treatment protocols are outlined. Specific conditions like normal pressure hydrocephalus and idiopathic intracranial hypertension are briefly mentioned. Prognosis is also covered.
1) High risk factors for seizure recurrence after a first unprovoked seizure include epileptiform abnormalities on EEG, a remote symptomatic cause identified on clinical history or neuroimaging, and an abnormal neurologic examination with focal findings or mental retardation.
2) AED treatment may be considered for patients with one or more of these high risk factors. While immediate AED treatment can reduce short-term seizure recurrence rates by 30-50%, it has little impact on long-term outcome and individual patient preferences regarding adverse effects should be taken into account.
3) Other potential risk factors with uncertain significance include a history of febrile seizures, family history of epilepsy, and seizures occurring during sleep. Status epilepticus
Encephalitis is inflammation of the brain parenchyma that can be caused by viral infections. Common symptoms include fever, headache, and altered mental status ranging from confusion to coma. Diagnosis involves lumbar puncture showing lymphocytic pleocytosis and elevated proteins in CSF. Treatment involves antivirals, managing increased intracranial pressure, and treating complications like seizures. Outcomes depend on virus virulence and patient factors, with risk of long-term neurological deficits and even death in severe cases. Nursing care focuses on monitoring for neurological changes, preventing injuries, and providing comfort throughout the illness and recovery process.
This document discusses different types of cerebral edema including cytotoxic, vasogenic, hydrostatic, osmotic, and hydrocephalic edema. It provides details on the causes, mechanisms, and management of each type. The key management strategies for cerebral edema discussed are head elevation, oxygenation, fluid management, seizure prophylaxis, fever control, nutrition, hyperventilation, osmotherapy using mannitol, and other adjunctive therapies.
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
Cerebrovascular disorders refer to any abnormality of blood supply to the brain. Stroke is a sudden neurological event caused by disrupted blood flow, and can be either ischemic (caused by blockage) or hemorrhagic (caused by bleeding). Ischemic strokes are more common and result in symptoms like motor or sensory loss, communication problems, and cognitive impairments. Diagnosis involves patient history, exam, imaging tests, and bloodwork. Treatment focuses on restoring blood flow and preventing complications. Nursing care addresses mobility, communication, bowel/bladder function, and helping patients and families cope.
Complications of various neurointerventional procedures and their managementNeurologyKota
This document discusses complications of various neurointerventional procedures and their management. It provides details on common complications related to vascular access, contrast induced nephropathy, diagnostic angiography, treatment of intracranial aneurysms, endovascular treatment of acute ischemic stroke, extracranial carotid angioplasty and stenting, intracranial angioplasty and stenting, and embolization procedures. It also gives tips and guidelines for prevention and management of various complications.
Fever is a common problem in the ICU, occurring in 30-70% of patients. It can be caused by infections, non-infectious factors, or a combination. A thorough evaluation including blood tests, imaging, and cultures is important to determine the cause. Common infectious causes include ventilator-associated pneumonia, catheter-related bloodstream infections, and urinary tract infections. Non-infectious causes include drug reactions, transfusions, and environmental factors. Prompt treatment of the underlying cause is key to avoiding adverse outcomes in critically ill ICU patients experiencing fever.
Central hyperthermia can occur after stroke or brain injury due to damage to the hypothalamus or brainstem centers that regulate temperature. It causes rapid onset fever without evidence of infection. Diagnosis involves ruling out infection and treatment uses a multimodal approach including medications like bromocriptine or baclofen to reduce fever by acting on dopamine or GABA receptors in the brain.
The document discusses prevention and management of delirium in the intensive care unit (ICU). It describes delirium as an acute brain dysfunction characterized by fluctuating attention and impaired cognition. Risk factors for delirium in the ICU include older age, comorbidities, and use of sedatives. While antipsychotics were historically used to treat delirium, recent studies found they do not reduce delirium duration or improve outcomes. The document recommends non-pharmacological prevention strategies and notes dexmedetomidine and statins may help prevent delirium by reducing inflammation and promoting normal sleep-wake cycles.
1) Dengue cases in Malaysia have significantly decreased in 2021 compared to the same period in 2020, with 16,565 cases reported so far this year versus 63,988 last year.
2) Dengue is caused by the dengue virus, which is transmitted by mosquitos and has four serotypes. Infection with one serotype provides lifetime immunity to that serotype but only short-term protection against the others.
3) Clinical evaluation of suspected dengue cases involves taking a thorough history, conducting a physical exam, ordering relevant lab tests like complete blood count and hematocrit, and assessing the disease phase and severity based on findings.
This document provides an overview of dengue fever, including its etiology, epidemiology, clinical presentation, diagnosis, complications and management. Some key points include:
- Dengue fever is caused by the dengue virus and transmitted by Aedes mosquitoes. There are four serotypes.
- It is prevalent in tropical and subtropical regions and cases have been increasing worldwide due to factors like increased travel and urbanization.
- Clinical presentation depends on whether it is a primary or secondary infection. Secondary infections are more likely to develop into severe dengue hemorrhagic fever or dengue shock syndrome.
- Diagnosis involves serological tests to detect IgM and IgG antibodies or the NS1 antigen. C
I worked on this presentation in 2017, for the Infectious disease department. My sources are: UpToDate, IDSA guidelines. Please share & give me credit to my work.
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major healthcare problem with high mortality rates, especially septic shock which has mortality rates of 50-60%.
2) The new Sepsis-3 definition defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection represented by an increase of two or more points in the SOFA score.
3) Early goal-directed therapy (EGDT) is a protocol-based approach for initial resuscitation of sepsis patients. It aims to achieve specific goals for central venous pressure, mean arterial pressure, ScvO2, and other parameters within 6 hours and
1. Status epilepticus is a medical emergency characterized by prolonged seizures without recovery between seizures or continuous seizure activity lasting more than 30 minutes.
2. It can be caused by not taking anti-seizure medications, infections, brain tumors, head trauma, or other underlying medical conditions.
3. Nursing care focuses on preventing injury during seizures, reducing fears and improving coping, providing education to patients and families, and monitoring for complications of prolonged seizure activity and medication side effects.
This document discusses catheter-related bloodstream infections (CRBSIs). It defines CRBSIs and describes different catheter types. CRBSIs are caused by pathogens migrating from the skin insertion site into the catheter or through direct contact. Common pathogens include staphylococci and candida. The document recommends a bundle of strategies to prevent CRBSIs, including education and training, maximal sterile barrier precautions, chlorhexidine skin antisepsis, securement devices, and antimicrobial catheters when infection rates remain high despite other measures. Regular assessment and performance improvement initiatives can help increase adherence to guidelines.
1. The document discusses intracranial pressure (ICP), cerebrospinal fluid (CSF) circulation and compensation mechanisms when ICP increases. It defines normal ICP and the factors that affect it, including the Monro-Kellie doctrine.
2. Symptoms of increased ICP are described, from early signs like headache to late signs like herniation and changes in vital signs. Different types of herniation are explained.
3. Methods for monitoring ICP are summarized, including invasive techniques like intraventricular and subdural monitors and non-invasive options. Indications for ICP monitoring include severe head injuries with abnormal CT scans or certain risk factors.
This document discusses cerebral edema, which occurs when excess fluid accumulates in the brain tissue leading to increased intracranial pressure. It classifies edema into cytotoxic, vasogenic, and interstitial types based on etiology. Cytotoxic edema results from cellular damage while vasogenic edema stems from blood-brain barrier disruption. Managing cerebral edema focuses on optimizing ventilation, intravenous fluids, blood pressure control, and using osmotherapy agents like mannitol to reduce brain water content.
Surg351 presentation and management of raised intracranial pressureepididymis
This document discusses raised intracranial pressure (ICP), including normal ICP, causes of increased ICP, clinical signs and symptoms, investigations, general treatment measures, and specific treatments for different causes. The normal ICP is around 10 mmHg, and ICP above 20 mmHg is considered pathological. Increased ICP can be caused by factors that increase the volume of brain, blood, or cerebrospinal fluid such as cerebral edema, hydrocephalus, or vascular dilation. Space-occupying lesions like tumors or abscesses can also cause elevated ICP. The general treatment approach involves measures to reduce ICP like head elevation, diuretics, hyperventilation, and sedation, as well as definitive treatments
Early onset of neonatal group b streptococcus diseases zharifDr Zharifhussein
- The document discusses Group B Streptococcus (GBS), a bacteria that can cause infections in newborn babies and other high-risk groups.
- GBS often colonizes the intestines or vagina without causing symptoms. It can be passed from mother to baby during childbirth and cause early or late-onset infections.
- Early-onset GBS infections usually occur within the first week of life and often present as sepsis, pneumonia, or meningitis. Late-onset infections typically occur between 1 week and 3 months of age and usually manifest as meningitis or sepsis.
- Guidelines recommend identifying high-risk mothers through GBS screening or risk factors like previous GBS-infected baby, G
The document discusses intracranial pressure (ICP), providing definitions and normal values. It describes cerebrospinal fluid (CSF) and autoregulation of cerebral blood flow. It covers evaluation of raised ICP including Monro-Kellie doctrine, Cushing's triad, and changes in the cranium. It discusses types of cerebral edema and causes of raised ICP. Clinical features, investigations, and general treatment protocols are outlined. Specific conditions like normal pressure hydrocephalus and idiopathic intracranial hypertension are briefly mentioned. Prognosis is also covered.
1) High risk factors for seizure recurrence after a first unprovoked seizure include epileptiform abnormalities on EEG, a remote symptomatic cause identified on clinical history or neuroimaging, and an abnormal neurologic examination with focal findings or mental retardation.
2) AED treatment may be considered for patients with one or more of these high risk factors. While immediate AED treatment can reduce short-term seizure recurrence rates by 30-50%, it has little impact on long-term outcome and individual patient preferences regarding adverse effects should be taken into account.
3) Other potential risk factors with uncertain significance include a history of febrile seizures, family history of epilepsy, and seizures occurring during sleep. Status epilepticus
Encephalitis is inflammation of the brain parenchyma that can be caused by viral infections. Common symptoms include fever, headache, and altered mental status ranging from confusion to coma. Diagnosis involves lumbar puncture showing lymphocytic pleocytosis and elevated proteins in CSF. Treatment involves antivirals, managing increased intracranial pressure, and treating complications like seizures. Outcomes depend on virus virulence and patient factors, with risk of long-term neurological deficits and even death in severe cases. Nursing care focuses on monitoring for neurological changes, preventing injuries, and providing comfort throughout the illness and recovery process.
This document discusses different types of cerebral edema including cytotoxic, vasogenic, hydrostatic, osmotic, and hydrocephalic edema. It provides details on the causes, mechanisms, and management of each type. The key management strategies for cerebral edema discussed are head elevation, oxygenation, fluid management, seizure prophylaxis, fever control, nutrition, hyperventilation, osmotherapy using mannitol, and other adjunctive therapies.
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
Cerebrovascular disorders refer to any abnormality of blood supply to the brain. Stroke is a sudden neurological event caused by disrupted blood flow, and can be either ischemic (caused by blockage) or hemorrhagic (caused by bleeding). Ischemic strokes are more common and result in symptoms like motor or sensory loss, communication problems, and cognitive impairments. Diagnosis involves patient history, exam, imaging tests, and bloodwork. Treatment focuses on restoring blood flow and preventing complications. Nursing care addresses mobility, communication, bowel/bladder function, and helping patients and families cope.
Complications of various neurointerventional procedures and their managementNeurologyKota
This document discusses complications of various neurointerventional procedures and their management. It provides details on common complications related to vascular access, contrast induced nephropathy, diagnostic angiography, treatment of intracranial aneurysms, endovascular treatment of acute ischemic stroke, extracranial carotid angioplasty and stenting, intracranial angioplasty and stenting, and embolization procedures. It also gives tips and guidelines for prevention and management of various complications.
Fever is a common problem in the ICU, occurring in 30-70% of patients. It can be caused by infections, non-infectious factors, or a combination. A thorough evaluation including blood tests, imaging, and cultures is important to determine the cause. Common infectious causes include ventilator-associated pneumonia, catheter-related bloodstream infections, and urinary tract infections. Non-infectious causes include drug reactions, transfusions, and environmental factors. Prompt treatment of the underlying cause is key to avoiding adverse outcomes in critically ill ICU patients experiencing fever.
Central hyperthermia can occur after stroke or brain injury due to damage to the hypothalamus or brainstem centers that regulate temperature. It causes rapid onset fever without evidence of infection. Diagnosis involves ruling out infection and treatment uses a multimodal approach including medications like bromocriptine or baclofen to reduce fever by acting on dopamine or GABA receptors in the brain.
The document discusses prevention and management of delirium in the intensive care unit (ICU). It describes delirium as an acute brain dysfunction characterized by fluctuating attention and impaired cognition. Risk factors for delirium in the ICU include older age, comorbidities, and use of sedatives. While antipsychotics were historically used to treat delirium, recent studies found they do not reduce delirium duration or improve outcomes. The document recommends non-pharmacological prevention strategies and notes dexmedetomidine and statins may help prevent delirium by reducing inflammation and promoting normal sleep-wake cycles.
1) Dengue cases in Malaysia have significantly decreased in 2021 compared to the same period in 2020, with 16,565 cases reported so far this year versus 63,988 last year.
2) Dengue is caused by the dengue virus, which is transmitted by mosquitos and has four serotypes. Infection with one serotype provides lifetime immunity to that serotype but only short-term protection against the others.
3) Clinical evaluation of suspected dengue cases involves taking a thorough history, conducting a physical exam, ordering relevant lab tests like complete blood count and hematocrit, and assessing the disease phase and severity based on findings.
This document provides an overview of dengue fever, including its etiology, epidemiology, clinical presentation, diagnosis, complications and management. Some key points include:
- Dengue fever is caused by the dengue virus and transmitted by Aedes mosquitoes. There are four serotypes.
- It is prevalent in tropical and subtropical regions and cases have been increasing worldwide due to factors like increased travel and urbanization.
- Clinical presentation depends on whether it is a primary or secondary infection. Secondary infections are more likely to develop into severe dengue hemorrhagic fever or dengue shock syndrome.
- Diagnosis involves serological tests to detect IgM and IgG antibodies or the NS1 antigen. C
Dengue is an acute febrile illness caused by one of four serotypes of the dengue virus transmitted by Aedes aegypti mosquitoes. Primary infection causes an IgM antibody response while secondary infection by a different serotype can cause severe dengue due to antibody-dependent enhancement. The disease progresses through three phases - febrile, critical, and recovery. The critical phase is characterized by increased vascular permeability leading to plasma leakage and potential development of shock. Diagnosis involves laboratory tests showing thrombocytopenia and hemoconcentration. Treatment is supportive and focuses on fluid management and antipyresis. Prevention relies on mosquito control and vaccine development.
The document discusses dengue, its causative virus, transmission cycle, clinical manifestations, diagnosis, and management in children. It describes how the dengue virus is transmitted between humans and mosquitoes, the four serotypes of the virus, and the typical 3 phase clinical course of dengue fever and dengue hemorrhagic fever. It provides guidelines for classifying and managing patients based on symptoms and severity, including outpatient and inpatient treatment and criteria for discharge.
The document discusses dengue, its causative virus, transmission, clinical manifestations, diagnosis, and management in children. It provides details on:
- The dengue virus having 4 serotypes and being transmitted by the Aedes aegypti mosquito.
- The replication and transmission cycle between humans and mosquitoes.
- Clinical manifestations ranging from dengue fever to the more severe dengue hemorrhagic fever and dengue shock syndrome.
- Diagnosis involving laboratory tests and clinical criteria.
- A stepwise approach to patient assessment and management categorized into outpatient, inpatient, and emergency groups.
- Dengue cases in Malaysia have declined significantly in 2021 compared to the same period in 2020, with weekly cases dropping from an average of 1,700-2,500 to 534 currently.
- Dengue is caused by the dengue virus, which is transmitted by mosquitoes and has four serotypes. Infection provides lifelong immunity to one serotype but only temporary protection against others.
- The course of dengue illness typically involves a febrile, critical, and recovery phase with symptoms ranging from mild fever to severe bleeding and organ impairment. Diagnosis involves assessing history, signs, blood tests like platelet count and hematocrit levels, and confirmation with antigen and antibody tests.
- Proper fluid management and
We will discuss briefly common tropical diseases found in INDIA. The presentation is basic for undergraduate students. we are covering dengue, malaria, chikungunya, and rickettsia in this presentation.
This document discusses tropical diseases with a focus on dengue and malaria. It provides details on the causative agents, transmission, clinical presentation, diagnosis and management of dengue and malaria. Dengue is caused by the dengue virus and transmitted by the Aedes mosquito. It presents as acute fever and can progress to severe dengue characterized by plasma leakage, bleeding and organ dysfunction. Malaria is caused by Plasmodium parasites and transmitted by Anopheles mosquitoes. It presents with fever and can lead to complicated malaria involving organ dysfunction. Diagnosis involves microscopy, rapid tests and PCR. Management focuses on supportive care, IV fluids and antimalarials depending on disease severity.
This document provides an overview of dengue fever management. It discusses the virus and vector, pathogenesis, clinical manifestations, investigations, severity grading, treatment approaches including fluid management, and discharge criteria. Key points include: dengue is caused by a flavivirus with 4 serotypes transmitted by Aedes aegypti mosquitoes; symptoms range from mild fever to potentially fatal shock; grading disease severity is important to determine management; intravenous fluids and monitoring for warning signs are the main treatment approaches.
This document provides information on Dengue virus, the mosquito vector Aedes aegypti, pathogenesis of Dengue fever and severe Dengue, classification of Dengue cases, investigations for diagnosis, and management approaches. It describes Dengue as a major public health problem spread by Aedes mosquitoes in tropical regions. It also covers Dengue virus properties, the four serotypes, and structural and non-structural proteins. Classification systems for Dengue fever, Dengue hemorrhagic fever, and Dengue shock syndrome are presented based on symptoms and lab findings.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
This document provides information on Dengue fever, including:
- It is caused by Dengue viruses 1-4 and transmitted by Aedes mosquitoes. Infection provides lifetime immunity to one serotype but not others.
- Symptoms range from mild fever to severe dengue hemorrhagic fever/dengue shock syndrome. Secondary infections carry higher risk of severe disease.
- Diagnosis involves physical exam, laboratory tests like platelet count and serology. There is no vaccine or antiviral treatment, only supportive care like fluids and fever control. Prevention focuses on mosquito control and avoidance of bites.
DENGUE - classification, symptoms and treatmentmansipatel951
Dengue is a prevalent arthropod-borne viral disease affecting over 100 million people annually. It is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. There are four serotypes of the dengue virus that cause illness. Symptoms include fever, headache, muscle and joint pains, and bleeding manifestations. Secondary infection with a different serotype increases the risk of developing severe dengue, characterized by plasma leakage, fluid accumulation, bleeding, and organ impairment. Treatment focuses on fluid replacement and management of warning signs such as abdominal pain and vomiting.
Dengue fever is a mosquito-borne viral disease caused by the dengue virus. It is transmitted by the Aedes aegypti mosquito. The disease affects around 100 million people worldwide each year, with cases increasing dramatically in recent decades. Dengue fever causes high fever, severe headache, muscle and joint pains, and a characteristic skin rash. In a small percentage of cases, it can develop into severe dengue hemorrhagic fever or dengue shock syndrome, which can be life-threatening without proper medical treatment. There is no vaccine available for dengue prevention.
Dr Deepak Dadhich DENGUE FEVER ppt under guidance of Dr Jitendra Verma Sir Pr...HakunaMatata198441
Dengue is caused by four serotypes of dengue virus transmitted by Aedes mosquitoes. The document discusses the pathophysiology, classification, clinical presentation, investigations and management of dengue. It describes the three phases of illness - febrile, critical and recovery phase. Treatment involves symptomatic relief and careful fluid management to prevent complications of plasma leakage and shock. Hospital admission is required if warning signs or severe symptoms are present.
Dengue fever is caused by the dengue virus transmitted by mosquitoes. It causes flu-like symptoms including fever, headache, muscle and joint pains. There are four types of dengue virus. Infection provides lifetime immunity to one type but only temporary protection against others. The disease progresses through febrile, critical, and recovery phases. In the critical phase, plasma leakage can cause dengue hemorrhagic fever or dengue shock syndrome, medical emergencies characterized by bleeding and circulatory failure. Diagnosis involves antigen and antibody testing. Treatment is supportive with rest and fluid replacement. Prevention focuses on controlling mosquito breeding habitats.
This document summarizes the management of severe dengue infection. It describes the typical clinical course and phases of dengue (febrile, critical, recovery). Diagnostic testing including rapid tests and ELISA are outlined. Management involves careful fluid resuscitation and treatment of specific complications such as bleeding, hepatitis, cardiac issues, and neurological problems. Intensive care management including mechanical ventilation and inotropes is warranted for persistent shock, respiratory failure, or acidosis.
DENGUE FEVER BY DR.RADHE.pptx CIVIL HOSPITAL NEPALRAMJIBANYADAV2
Dengue fever is a mosquito-borne viral illness that has spread rapidly worldwide. It is transmitted by Aedes mosquitoes and causes flu-like symptoms including fever, headache, muscle pain and rash. There are four distinct serotypes of the dengue virus. Most cases resolve without complications, but severe dengue can occur, characterized by plasma leakage, bleeding or organ impairment. Treatment depends on severity of symptoms and involves oral rehydration or intravenous fluids and blood transfusions in severe cases.
Similar to Dengue fever -more than enough information and what you need to know (20)
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
6. • Female Aedes aegypti mosquito
• Extrinsic incubation period – 10 to
14 days
• Temperature may alter the extrinsic
incubation period
• Remains infective till it dies
11. PRIMARY INFECTION
• Anti Dengue Ig M appears within 2-
3days of defervescence peaking at 2
weeks after the onset of symptoms
• Anti Dengue Ig G appears afterwards
12. SECONDARY INFECTION
• Ig G -dominant
• Ig M – much lower
• No protection against different
strain of virus
44. GROUP A –OPD
• Encourage fluid intake
• Paracetamol
• Monitor fluid intake , urine output ,
fever , bleeding & altered sensorium
• Bring back if any of the warning signs
present
45. GROUP B-INPATIENT
• Obtain base line Haematocrit
• Start isotonic fluids
• Reassess Clinical status
• Repeat HCT
• Review Fluid infusion rates till the child is
better
46. GROUP C -ICU
• HCT , Blood Count & Organ function test
• Compensated Shock Management
• Hypotensive Shock Management
47.
48.
49. GROUP C -ICU
• Packed cell transfusion if Indicated
• Monitor vital signs 4 hrs once
• Monitor HCT before & after fluid
replacement
• Monitor temp,HR,BP,PR.
Antibody- dependent enhacement of dengue virus
Enhanced virus replication in monocytes in presence of subneutralizing levels
IN asymptomatic dengue infection= host develops immunity to serotype of infecting strain
Cross-protective antibodies don’t neutralize but help viral uptake with Fcgamma receptor (expressed on monocytes and macrophages) in monocytes (Textbook of critical care)
After initial infection : homotypic and neterotypic neutralizing antibodies are produced
Over time, heterotypic decrease and homotypic increase
Production of heterotypic antibodies that neutralize virus partially
Deliver virus to cells in the compartment where it is not destroyed, instead it replicates
Response dominated by antibodies to structural precursor-membrane protein (prM)
At high concentration, cannot neutralize and highly cross reactive
(Cross-reacting antibodies enhance dengue firus infection in humans)
(Intrinsic antibody-dependent ehancement of microbial infection in macrophages: disease regulation by immune complexes)
(Enhancing cross-reactive anti-prM dominates the human antibody response in dengue infection)
Antibody- dependent enhacement of dengue virus
Enhanced virus replication in monocytes in presence of subneutralizing levels
IN asymptomatic dengue infection= host develops immunity to serotype of infecting strain
Cross-protective antibodies don’t neutralize but help viral uptake with Fcgamma receptor (expressed on monocytes and macrophages) in monocytes (Textbook of critical care)
After initial infection : homotypic and neterotypic neutralizing antibodies are produced
Over time, heterotypic decrease and homotypic increase
Production of heterotypic antibodies that neutralize virus partially
Deliver virus to cells in the compartment where it is not destroyed, instead it replicates
Response dominated by antibodies to structural precursor-membrane protein (prM)
At high concentration, cannot neutralize and highly cross reactive
(Cross-reacting antibodies enhance dengue firus infection in humans)
(Intrinsic antibody-dependent ehancement of microbial infection in macrophages: disease regulation by immune complexes)
(Enhancing cross-reactive anti-prM dominates the human antibody response in dengue infection)
Antibody- dependent enhacement of dengue virus
Enhanced virus replication in monocytes in presence of subneutralizing levels
IN asymptomatic dengue infection= host develops immunity to serotype of infecting strain
Cross-protective antibodies don’t neutralize but help viral uptake with Fcgamma receptor (expressed on monocytes and macrophages) in monocytes (Textbook of critical care)
After initial infection : homotypic and neterotypic neutralizing antibodies are produced
Over time, heterotypic decrease and homotypic increase
Production of heterotypic antibodies that neutralize virus partially
Deliver virus to cells in the compartment where it is not destroyed, instead it replicates
Response dominated by antibodies to structural precursor-membrane protein (prM)
At high concentration, cannot neutralize and highly cross reactive
(Cross-reacting antibodies enhance dengue firus infection in humans)
(Intrinsic antibody-dependent ehancement of microbial infection in macrophages: disease regulation by immune complexes)
(Enhancing cross-reactive anti-prM dominates the human antibody response in dengue infection)
NS1 antigen = glyprotein secreted from dengue-infected cells , necessary for viral replication
NS1 binds to heparan sulphate on microvascular endothelial cell
= facillitates immune complex formation and complement activation
( Secreted NS1 of dengue virus attaches to the surface of cells via interactions with heparan sulfate and chondroitin sulfate)
(Vascular leakage in severe degue virus infections: a potential role for the nonstructural viral protein NS1 and complement)
Cross-reactive antibodies to the dengue virus can acivate complement on the surface of endothelial cells
Release of C3a and C5a anaphylatoxins has been associated with leakage and shock
NS1 = disease severity
Able to activate complement leading to local and systemic production of C5a and Sc5n-9 complexes
Detected in patients with severe degue
NS1= complement attenuation as well through classical and lectin pathways, reduce capacity of C$
= LOCAL activation of complement = activatin of endothelial cells = vascular leakage
Monocytes – most susceptible cell population to dengue virus infection
Production of TNF alpha resulting in endothelial cell activation
PRODUCTION OF VASOACTIVE FACTORS
T lymphocytes may also exacerbate tissue injury (relevant during secondary dengue infection
Found that T cross-reactive memory T lympcytes induced by primary dengue virus infection proliferate more rapidly during secondary exposure to dengue virus (can react to many flavivirus epitopes and other straings of degue)
Activation of dengue specific T lymphocytes = increased permeability
1) CD4+ T cell = IFN-gamma, IL2, TNF alpha, TNF B
TNF alpha =plasmal leakge and shock
IL-2 = induce plasma leakage
IFN- gamma = increase TNF alpha production by activating monocytes, interacts with TNF alpha to activate endo cells, enhance the presentation of viral antigens to T cells (in crease expression of II HLA antigens and increased expression of IGG receptors augments uptake of virus in monocytes)
Activated T cells – target cell lysis, able to lyse dengue virus-infected cells, lysed infected autologous cells, also lyse uninfected cells by interaction between FasL on T cell and Fas on target cell)
TNF alpha with more severe disease
IFN-gamma elevation more frequently seen in DHF
Soluable CD4, CD8, and IL2 receptors and TNF receptors in plasma = immune activation
Saw elevation two days before plasma leakage
Monocytes – most susceptible cell population to dengue virus infection
Production of TNF alpha resulting in endothelial cell activation
PRODUCTION OF VASOACTIVE FACTORS
T lymphocytes may also exacerbate tissue injury (relevant during secondary dengue infection
Found that T cross-reactive memory T lympcytes induced by primary dengue virus infection proliferate more rapidly during secondary exposure to dengue virus (can react to many flavivirus epitopes and other straings of degue)
Activation of dengue specific T lymphocytes = increased permeability
1) CD4+ T cell = IFN-gamma, IL2, TNF alpha, TNF B
TNF alpha =plasmal leakge and shock
IL-2 = induce plasma leakage
IFN- gamma = increase TNF alpha production by activating monocytes, interacts with TNF alpha to activate endo cells, enhance the presentation of viral antigens to T cells (in crease expression of II HLA antigens and increased expression of IGG receptors augments uptake of virus in monocytes)
Activated T cells – target cell lysis, able to lyse dengue virus-infected cells, lysed infected autologous cells, also lyse uninfected cells by interaction between FasL on T cell and Fas on target cell)
TNF alpha with more severe disease
IFN-gamma elevation more frequently seen in DHF
Soluable CD4, CD8, and IL2 receptors and TNF receptors in plasma = immune activation
Saw elevation two days before plasma leakage
(Original antigenic sin in dengue revisited)
Monocytes – most susceptible cell population to dengue virus infection
Production of TNF alpha resulting in endothelial cell activation
PRODUCTION OF VASOACTIVE FACTORS
T lymphocytes may also exacerbate tissue injury (relevant during secondary dengue infection
Found that T cross-reactive memory T lympcytes induced by primary dengue virus infection proliferate more rapidly during secondary exposure to dengue virus (can react to many flavivirus epitopes and other straings of degue)
Activation of dengue specific T lymphocytes = increased permeability
1) CD4+ T cell = IFN-gamma, IL2, TNF alpha, TNF B
TNF alpha =plasmal leakge and shock
IL-2 = induce plasma leakage
IFN- gamma = increase TNF alpha production by activating monocytes, interacts with TNF alpha to activate endo cells, enhance the presentation of viral antigens to T cells (in crease expression of II HLA antigens and increased expression of IGG receptors augments uptake of virus in monocytes)
Activated T cells – target cell lysis, able to lyse dengue virus-infected cells, lysed infected autologous cells, also lyse uninfected cells by interaction between FasL on T cell and Fas on target cell)
TNF alpha with more severe disease
IFN-gamma elevation more frequently seen in DHF
Soluable CD4, CD8, and IL2 receptors and TNF receptors in plasma = immune activation
Saw elevation two days before plasma leakage