This document discusses dengue virus and dengue fever. It provides details on the virology of dengue virus, the pathophysiology of disease including antibody dependent enhancement and cytokine storm. It describes the clinical spectrum of disease from asymptomatic to severe forms. Diagnosis, management of different stages of the disease including shock are discussed along with differential diagnosis. Complications like bleeding, organ involvement, warning signs for progression to severe disease are explained.
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
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Mosquito borne viral infection
Major public health concern
No specific treatment
Supportive care at the right time – life saving
3. Globally – 50 million infections
anually
SEAR and Western pacific –
75% of global burden
India – endemic for dengue
fever
July – November – upsurge in
cases
Perennial transmission in
south india
4. ss RNA virus belonging to Flaviviridae family
3 structural protein genes encoding core
protein (C), envelope protein (E), membrane
associated protein (M)
7 non structural proteins ( Envelope
glycoprotein NS1)
four virus serotypes --DENV-1, DENV-2, DENV-3
and DENV-4
Infection with one serotype – lifelong immunity
to that serotype
Secondary infection with another serotype –
severe dengue infection
5. Aedes aegypti
Highly domesticated
Breeds in man made water
receptacles
Strongly anthrophilic
Nervous feeder
Discordant species
Aedes albopitcus
Feeds on both humans and
animals
Aggressive feeder
Concordant species
6.
7. Female Aedes takes blood meal from an infected person ( viremic stage)
Extrinsic incubation period (8-10 days)
bites a person and injects saliva
Intrinsic incubation period of 4-7 days ( range 3 – 14 days)
Patient develops symptoms
9. Dengue virus taken up by dendritic cells; antigen processing
Antibodies against E, M and NS1 protein
Neutralizng and non-neutralizing antibodies produced
Non neutralizing Ab bind to virus, but doesn’t destroy virus
Virus entry into host cell enhanced
Antibody Dependent Enhancement of infection (ADE)
Cytokine Storm
16. mild to moderate fever
similar to other viral illness
may have maculopapular rash during fever or defervescence
no capillary leak or coagulopathy
17. Acute febrile illness of 2-7 days duration with 2 or more of the
following:
headache
Retro orbital pain
myalgia and/or arthralgia
Rash
haemorrhagic manifestation
18. 1) Mild dengue- fever without complications like bleeding,
hypotension, organ involvement or without evidence of
capillary leak.
2) Moderate dengue
a) mild dengue fever in those with comorbid conditions
like infancy, elderly, obese, pregnancy, asthma, dm, htn,
peptic ulcer, CAD, on steroids/ immunosuppressive drugs,
hiv, antiplatelet/anticoagulants.
b) Dengue fever with warning signs
19. recurrent vomiting( 3 in 1 hr /4 in 6 hrs)
intense and persistent abdominal pain/tenderness
general weakness/lethargy/restlessness
minor mucous membrane bleeding(epistaxis, gum bleeding,
oral bleeding)
hepatomegaly/mild hepatic dysfunction
mild pleural effusion/ascites
increasing haematocrit/decreasing platelet count.
progressive rise in haematocrit in atleast 2 consecutive
measurements.
20. Inflate the BP cuff midway between systolic and diastolic BP
for 5 min and count the no of petechiae in 1 square inch area
in the elbow
More than 10 is taken as positive
False negative- obese and profound shock
21. 1) DF with significant haemorrhage
2)DHF with shock
3) Severe organ involvement(expanded organ syndrome- CNS, hepatic, renal,
cardiac, pulmonary, eye]
4) Severe metabolic derangements (metabolic acidosis, hyponatremia,
hypocalcemia, hypokalemia, hyperkalemia, hypoalbuminemia)
22.
23. DF- fever 2-7 days with 2 or more of the following –headache,
retroorbital pain, myalgia, arthralgia with or without leukopenia,
thrombocytopenia and no evidence of plasma leakage.
DHF I : Above criteria + positive tourniquet test + evidence of
plasma leakage
Thrombocytopenia with platelet count less than 1 lakh and PCV
rise more than 20% over baseline
DHF II - Above plus some evidence of spontaneous bleeding in skin
or other organs
24. DHF III(DSS)-
Above plus
circulatory failure(weak rapid pulse, narrow pulse pressure <
20mm Hg, hypotension,cold clammy skin, restlessness)
DHF IV(DSS)- Profound shock with undetectable BP or pulse
25. Vertical transmission reported
Capillary leakage and bleeding tendency
Clinical manifestations
Mild-- fever with petechial rash, thrombocytopenia, and
hepatomegaly.
Severe – pleural effusion , gastric bleeding, circulatory
failure, massive ich
Timing of maternal infection may be important – peripartum
maternal infection leads to symptoms in baby
Transplacental transfer of antibodies
26. Asymptomatic / mild / severe (4 – 9 months )
High fever 2-7 days
URTI and gastrointestinal symptoms more common
Febrile convulsions maybe seen
During defervescence, increased permeability and hemoconcentration
Petechiae, mucosal and GI bleeding
Hepatomegaly and splenomegaly
Capillary leak shock
Rise in Hct maybe missed – as normal Hct low in this age; also superadded
Fe def anemia maybe there
30. Pulse pressure less than 20mm hg or
Rapid, low volume pulse with any 2 of the following- CFT >2 sec,cold
clammy skin, mottling
SBP < 60mm hg in newborn
< 70mm hg in 1 – 12 months
< 70 + age x 2 in 1- 10yrs
< 90 in more than 10yr old.
MAP < 40 + age x 1.5 in 1- 10yr
< 70mm hg in adults
31. NS1 ANTIGEN TEST
Detection of NS1 antigen in blood
During viremia
ELISA based test
Positive from day 1 , upto day 4-5
DENGUE IgM TEST
IgM capture MAC ELISA
Positive from Day 5
32.
33. 1)1-3 days of fever/febrile phase/first contact
Suspect dengue in any child who presents especially during an
outbreak with at least 2 of the following with fever:
- Headache - Lethargy
-Retroorbital pain -Rash
-Mylagia -Arthralgia
-bleeding manifestation(including positive tourniquet test)
-TC less than 5000
-Plt less than 1.5
-Rising haematocrit by more than 10-15%
34. Paracetamol 10mg/kg q6h.
Avoid nsaids, steroids, antibiotics
Encourage plenty of oral fluids like ORS, salted kanji, coconut
water etc
Plain water leads to hyponatremia and may contribute to leakage
of fluid into interstitial space
35. Avoid IV fluids during this stage
If IV fluids are given - isotonic iv fluids DNS or plasmalyte at
1.5ml/kg/hr
Ensure adequate urine output of >1ml/kg/hr and normal vitals
Only 1/3rd of the fluid administered will remain in the intravascular
compartment
Rest will go into the interstitial compartment
Resorption will occur only during the resorptive phase
36. 2)3-5 days of fever/critical phase:
Step 1-categorise as DF or DHF
- classically DHF is defined as evidence of haemorrhage
(spontaneous or positive tourniquet test) and capillary leak in a pt
with fever and platelet count less than 1 lakh
Evidence of capillary leak includes
- increase in haematocrit by more than 20%
- ascites or pleural effusion by chest XRAY, USG or clinical examination
- gall bladder edema
- S.albumin less than 3.5g/dl
A low ESR < 10mm/hr differentiates dengue shock from septic shock
38. - Look for warning signs or signs of severe dengue
- Early stages of shock are characterised by narrow pulse pressure as,
in dengue there is no circulation of lipopolysaccharides
- Wide pulse pressure shock may occur if there is coinfection with
bacteria ,hepatic failure or in neurogenic shock due to dengue
encephalitis.
39. S.Ca
Trop T or I
ABG
Blood culture
Urine analysis/myoglobin
USG and Echo
40. Start with 6ml/kg/hr with target urine output of 1ml/kg/hr
Escalate or deescalate according to urine output every hr
Extra fluid in this stage deleterious -- fluid will accumulate in the
interstitium compromising respiration, fluid and nutrient delivery
Monitor hourly vitals and haematocrit 4th hourly
If the child requires more than three 10ml/kg/hr bolus without
improvement or rising haematocrit , it should be considered as severe
dengue and managed accordingly
41.
42.
43. Start O2 by NRM
Administer crystalloid –NS or plasmalyte @ 20ml/kg/hr if pulses are
absent (WHO recommends 20ml/kg over 15 to 30min)
Monitor vitals every 15min.
Once the pulse appears, decrease rate to 10ml/kg/hr
Measure haematocrit 2 to 4hrly.
If the pt does not improve, continue 10 – 20ml/kg/hr
44.
45.
46.
47.
48. if 60ml/kg of crystalloids have been given -- consider colloids
Dextran 40 preferred over hexa starch-dose 10ml/kg/hr
Dextran 10ml/kg decreases PCV by 10 points
If more than that - consider bleed
If no improvement- second dose given
Limit – 30ml/kg/day
49. A -acidosis
Give bicarbonate 1ml/kg if ph < 7.3 with bicarbonate less than 15
( In septic shock- bicarbonate is given if ph < 7.15 with refractory
shock not responding to inotropes and fluids)
B -bleed –
Whole blood 10ml/kg or packed cell 5ml/kg
50. Clinically severe bleed > 6 – 8 ml/kg of body wt
Worsening metabolic acidosis
Unstable vitals with normal or low pcv
Rise in PCV of less than 20% with persistent shock
Refractory shock inspite of 60ml/kg of fluids
51. Mandatory to check PCV before and after transfusion
If PCV does not rise – consider continuing bleed and repeat blood
transfusion if vitals remain unstable
Rate of transfusion
– in hypotensive shock – give over 1hr
Otherwise at 2- 5ml/kg/hr
52. C – coagulopathy –
Priority is for fluid and blood transfusion, but if severe bleeding
continues, correction of coagulopathy is given
If fibrinogen levels < 100mg/dl, give cryoprecipitate @ 0.15 u/kg or
2units per 10kg or 5 – 10ml/kg
Cryo can also be used when there is fluid overload with coagulopathy
and bleed.
53. Tranexemic acid 15mg/kg f/b 2mg/kg/hr for aTLeast 8hrs or till
bleeding stops
In case of massive bleed (> 40ml/kg in 3hrs or > 3ml/kg/min),
transfuse PRC: FFP: platelet – 2: 1: 1
C – calcium-
treat hypocalcemia with calcium gluconate 1ml/kg slow iv
D – dextrose
treat hypoglycaemia with D 10 2-4 ml/kg and increasing
concentration of dextrose concentrations
54. Consider inotropes if child does not respond to above fluid
management- maintenance plus 5% plus inotropes
Unrecordable BP as a salvage inotrope- Adrenaline @ 0.05 –
0.3 mcg/kg/min
Wide pulse pressure shock –Noradrenaline @ 0.05 –
1mcg/kg/min
BP normal with poor perfusion, worsening acidosis –
dobutamine @ 5 – 20 mcg/kg/min
55. Cardiogenic shock – Dobutamine
Hypotensive cardiogenic shock- Adrenaline
Cardiogenic shock with severe tachycardia – Milrinone
0.3 – 0.7mcg/kg/min
Levosimendan – used in diastolic dysfunction,in presence of severe
tachycardia, pulmonary hypertension or if the child is not
responding to dobutamine esp after 72hrs.
If BP is not maintained at Adrenaline 0.3mcg/kg/min give
Hydrocortisone 2 -4 mg/kg /day in divided doses
56. Ventilation- consider NIV early in the course of disease if child has
respiratory distress, shock not responsive to fluids or
catecholamine refractory
IV access-try to secure iv lines early.
57. IV dextran 10ml/kg over 1hr
Usually BP is restored in 10- 30min -- then give Inj furosemide 0.1mg/kg
Monitor vitals every 15min as child can go into shock due to diuresis
In case of severe fluid overload, dextran may be repeated with repeat
furosemide at 30-60min interval but subsequent should be titrated
according to urine output
Even in spite of large doses of lasix and decreased urine output,if IVC is
full,it may indicate renal failure and need for RRT
58. Death usually occurs due to massive brain edema leading to
herniation. Can present with brainstem involvement during any
phase of dengue
Treat seizures or add prophylactic fosphenytoin
Give 3% NS 5ml/kg over 1hr
Target S.Na of 145-150meq/l
Use isotonic fluids for resuscitation
59. Intubate if GCS< 8 or rapidly decreasing by more than 3 points
Hyperventilate with bag and mask
Sedate with lora 0.1mg/kg and fentanyl 1mcg/kg
Give lignocaine 1mg/kg to prevent ICP surge due to gagging
paralyse with vecuronium 0.1mg/kg and intubate
Post intubation keep a higher pCO2 30 – 35mm Hg in the first 24
hrs
60. Characterised by improvement in general well being, increase in
s.albumin and stabilisation of vitals
fall in PCV and increased urine output
WATCH FOR PULMONARY EDEMA
stop iv fluids completely
if child is not diuresing, consider furosemide @ 0.1 – 1mg/kg/hr
61. Loss of blood (overt blood) - 10 per cent or more of total blood
volume - preferably give whole blood or components to be used
Refractory shock despite adequate fluid administration and
declining haematocrit
Replacement volume should be 10 ml/kg body weight at time
and coagulogram should be done
If fluid overload is present packed cells are to be given
62. Prophylactic platelet transfusion may be given at levels of <10000
in the absence of bleeding manifestations
Prolonged shock with coagulopathy and abnormal coagulogram
In case of systemic bleeding, platelet transfusion may be needed
in addition to red cell transfusion
63. Absence of fever for at least 24 hrs without use of antipyretics
No respiratory distress from pleural effusion or ascites
Platelet count > 50000
Good urine output.
Return of appetite
Minimum of 2- 3 days after recovery from shock
Visible clinical improvement
64.
65. Difficult to distinguish symptoms and signs because of their
overlapping initial clinical presentations and laboratory
parameters
both have an unpredictable clinical course and both
generally require in-hospital monitoring for management
Most of the hospitals are busy with managing COVID-19 at
present, and a very little window is open to tackling another
disease outbreak.
Most of the cases of COVID-19 and dengue are asymptomatic
(about 80%). In a setting of coinfection, one might enhance
the severity of the other
66. IV fluid therapy is challenging in coinfected patients due to
early development of ARDS/pulmonary oedema
Treatment with Low molecular weight heparin for
management of COVID-19 may enhance bleeding in the
presence of dengue, especially with low platelet count
False positivity is also reported among co-infection, which
may create a diagnostic challenge
Both viral diseases do not have any specific antivirals drugs
67.
68.
69. 1. FLUID MANAGEMENT:
Can proceed as usual
If SARI, aggressive fluid therapy- worsen oxygenation
IVC guided fluid therapy
2. LMWH :
If thrombocytopenia, should be careful
Stop immediately, if active bleed
3. STEROIDS :
can be given as per COVID protocol
70. National guidelines clinical management of dengue
PARK SPM TEXTBOOK
SAT Protocol