The document provides guidelines on dengue infection, discussing the clinical syndromes of dengue fever and dengue hemorrhagic fever, their diagnosis and classification, management approaches including fluid resuscitation, and treatment of complications. It describes dengue virus and the disease it causes, including its pathophysiology, clinical course, and atypical manifestations. Risk factors, vectors, and the immune response to primary and secondary infections are also covered.
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 primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
Risk factors for progression of chronic HBV include the following :
Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT), as well as the presence of core and precore mutations seen most commonly in HBV genotype C and D infections
Male sex
Older age
Family history of HCC
Alcohol use
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
A synergistic approach of suppressing viral load and boosting the patient’s immune response with immunotherapeutic interventions is needed for the best prognosis. The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues.
HBV infection can be self-limited or chronic. No specific therapy is available for persons with acute hepatitis B; treatment is supportive.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Dengue virus rarely causes death. However, the infection can progress into a more serious condition known as severe dengue or dengue hemorrhagic fever. Symptoms of dengue hemorrhagic fever include: bleeding under the skin. frequent vomiting.
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
Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.
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 primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
Risk factors for progression of chronic HBV include the following :
Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT), as well as the presence of core and precore mutations seen most commonly in HBV genotype C and D infections
Male sex
Older age
Family history of HCC
Alcohol use
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
A synergistic approach of suppressing viral load and boosting the patient’s immune response with immunotherapeutic interventions is needed for the best prognosis. The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues.
HBV infection can be self-limited or chronic. No specific therapy is available for persons with acute hepatitis B; treatment is supportive.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Dengue virus rarely causes death. However, the infection can progress into a more serious condition known as severe dengue or dengue hemorrhagic fever. Symptoms of dengue hemorrhagic fever include: bleeding under the skin. frequent vomiting.
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
Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.
Dengue is a febrile illness caused by a flavivirus transmitted by Aedes aegypti or Aedes albopictus mosquitoes while taking a blood meal. There are four dengue virus (DENV) types (DENV-1, DENV-2, DENV-3, and DENV-4), all of which are capable of inducing severe disease (dengue hemorrhagic fever [DHF]/dengue shock syndrome [DSS]). Dengue is endemic in more than 125 countries in tropical and subtropical regions and causes an estimated 390 million infections annually worldwide, of which 96 million are clinically apparent
In dengue-endemic regions, suspected, probable, and confirmed cases of dengue infection should be reported to the relevant authorities as soon as possible, so that appropriate measures can be instituted to prevent dengue transmission
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
2. Dengue viral infection
● The most rapidly spreading mosquito-borne viral
disease in the world
● Dengue virus :
4 serotypes : DEN1, DEN2,DEN3, and DEN4
Family Flaviviridae
Genus Flavivirus
Single stranded RNA virus
● “Asian” genotypes of DEN-2 and DEN-3 :
frequently associated with severe disease
accompanying secondary dengue infections
3.
4. Average annual number of DF and DHF cases reported to WHO, and of countries reporting dengue,
1955–2007
5. Dengue Virus Infection
● Immunity : long lasting in same serotype, partial and
transient to other serotypes
● Primary infection, secondary infection
● Greater risk of serious symptoms in secondary
infection
• Plasma leakage distinguishes dengue fever from
dengue hemorrhagic fever
• Plasma leakage,hemoconcentration and abnormalities
in homeostasis characterize severe dengue
6. Dengue Virus Infection:
Clinical Syndromes
● Undifferentiated fever
● Dengue fever: fever, headache, muscle pain,
nausea/vomiting, rash
● DHF
● DSS
Gr I, II
Plasma leakage
Gr III, IV
7. Definition of Dengue Hemorrhagic
Fever
4 necessary criteria:
• Fever, or recent history of acute fever
• Hemorrhagic manifestations
● Low platelet count (100,000/mm3 or less)
● Objective evidence of “leaky capillaries”
elevated hematocrit (20% or more over baseline)
pleural or other effusions
Fall in hematocrit >20% after I.V Fluids
8. Definition of Dengue Shock Syndrone
4 criteria for DHF
● Evidence of circulatory failure manifested indirectly
by all of the following:
Rapid and weak pulse
Narrow pulse pressure (< 20 mm Hg) OR hypotension
for age
Cold, clammy skin and altered mental status
● Frank shock is direct evidence of circulatory failure
9. WHO classification
● Undifferentiated fever
● Dengue fever (DF)
● Dengue haemorrhagic fever (DHF)
4 severity grades
grades III and IV : dengue shock syndrome (DSS)
● Currently the classification into DF/DHF/DSS
continues to be widely used
11. ● patients with non-severe dengue
patients with warning signs
patients without warning signs
● “dengue is one disease entity with different clinical
presentations and often with unpredictable clinical
evolution and outcome”
14. Dengue
● incubation period of 4-10 days
● wide spectrum of illness (most, asymptomatic or
subclinical)
● Primary infection : induce lifelong protective
immunity to the infecting serotype
● Individuals suffering an infection are protected
from clinical illness with a different serotype
within 2-3 months of the primary infection
● no long-term cross-protective immunity
15. Risk factors (determine the severity of disease
and secondary infection)
● Age
● Ethnicity
● Possibly chronic diseases (bronchial asthma, sickle
cell anemia and DM)
● Young children (less able to compensate for capillary
leakage and are consequently at greater risk of
dengue shock)
● Secondary heterotypic infection as risk factor for
severe dengue
17. Febrile phase
● High-grade fever, 2–7 days
● facial flushing, skin erythema, body ache, myalgia, arthralgia,
headache and N/V
● Indistinguishable between severe and non-severe dengue cases
● Monitoring for warning signs
● Mild hemorrhagic manifestations : petechiae and mucosal
membrane bleeding (e.g. nose and gums)
● Liver often enlarged and tender after a few days of fever
● The earliest abnormality in CBC : progressive decrease in
WBC
18. The course of dengue illness
Dengue: Guidelines for diagnosis, treatment, prevention and control. WHO 2009
19. Critical phase
● Day 3–7 of illness
● Progressive leukopenia rapid ↓platelet count plasma
leakage
● Patients without ↑capillary permeability will improve
● Patients with ↑capillary permeability : worse, lose plasma
volume
● The degree of increase above the baseline HCT reflects
severity of plasma leakage
• Shock-WBC may increase in patients with severe bleeding
20. The course of dengue illness
Dengue: Guidelines for diagnosis, treatment, prevention and control. WHO 2009
21. Recovery phase
● Gradual reabsorption of extravascular compartment fluid
takes place in the following 48–72 hours
● Well-being improves, appetite returns, GI symptoms abate,
hemodynamic status stabilizes and diuresis ensues
● Rash : “isles of white in the sea of red” Some may
experience generalized pruritus
● Hct stabilizes or lower due to the dilutional effect of
reabsorbed fluid
● WBC usually rise soon after defervescence but the recovery
of platelet count is typically later than that of WBC
22. Febrile, critical and recovery phases in
dengue
Febrile phase Dehydration; high fever may cause
neurological disturbances and febrile
seizures in young children
Critical phase Shock from plasma leakage; severe
hemorrhage; organ impairment
Recovery phase Hypervolemia (only if iv fluid therapy
has been excessive and/or
has extended into this period)
23. Severe dengue
● Fever of 2–7 days plus any of the following
Evidence of plasma leakage :
high or progressively rising Hct
pleural effusions or ascites
circulatory compromise or shock (tachycardia, cold and clammy
extremities, capillary refill time > 3 seconds, weak or undetectable
pulse, narrow PP or, in late shock, unrecordable BP)
Significant bleeding
Altered level of consciousness (lethargy or restlessness, coma,
convulsions)
Severe GI involvement (persistent vomiting, increasing or intense
abdominal pain, jaundice)
Severe organ impairment (acute liver failure, ARF, encephalopathy or
encephalitis, or other unusual manifestations, cardiomyopathy)
27. Primary Infection
● NS1 antigen : Day 1 after onset of fever and up to day 9
● IgM antibody :
Day 5 of infection, sometimes as early as Day 3
IgM levels : peak in 2 weeks, followed by a 2 week rapid
decay
Undetectable 2 to 3 months after infection
● Low levels of IgG are detected in the early convalescent
phase, not during the acute phase
28. Secondary Infection
● NS1 antigen : day 1 after onset of fever and up to day 9
● IgM response is more varied
● Usually preceded by IgG and appears quite late during the
febrile phase
● Minority of patients will show no detectable levels of IgM
● May not be produced until 20 days after onset of infection
● High levels of IgG are detectable during the acute phase
● Persist for 30-40 days then decline to levels found in primary
or past infection
29. Atypical neurological manifestations
of dengue
● Neurologic abnormalities : uncommon during dengue
fever
● DHF, encephalopathy is well recognized, from
several factors
cerebral anoxia
cerebral edema
cerebral hemorrhage
hyponatremia
toxicity secondary to liver failure
● Studies in southeast Asia, encephalopathy associated
with classic DF can occur in up to half of the cases
30. Atypical gastrointestinal
manifestations of dengue
• Hepatitis
Hepatomegaly, jaundice and raised aminotransferase levels
(AST>ALT)
caused by the dengue virus and ⁄or Hypoxia and tissue ischemia
in cases of shock
• Fulminant hepatic failure
Severe hepatic dysfunction (ALT and AST >10x normal) was
seen with DHF associated with spontaneous bleeding tendencies
tends to occur more often in DHF or DSS compared to classic
dengue infections
• Acalculous cholecystitis
• Acute pancreatitis
31. Atypical cardiovascular manifestations
of dengue fever
● uncommon
● Cardiac rhythm disorders :
atrioventricular blocks
atrial fibrillation
sinus node dysfunction
ectopic ventricular beats
● Most are asymptomatic, benign self limiting course with
resolution of infection
● Attributed to viral myocarditis
32. Atypical respiratory manifestations of
dengue
● ARDS
● Pulmonary hemorrhage : thrombocytopenia,
changes in vascular permeability, platelet
dysfunction
33. Dengue myositis
● Dengue fever : break bone fever, severe muscle, joint
and bone pain
● Acute benign myositis : elevated SGOT, SGPT, and
CPK
● Dengue virus infection may also cause persisting,
severe, myositis for weeks
34. Lymphoreticular complications of
dengue
● Dengue virus antigen is found predominantly in cells
of the spleen, thymus and lymph nodes
● DHF, lymphadenopathy is observed in half of the
cases
● Splenomegaly is rarely observed
● Splenic rupture and lymph node infarction in DHF
are rare
36. A stepwise approach to the
management of dengue
Step I. Overall assessment
History : symptoms, past medical and family history
Physical examination : full physical and mental assessment
Investigation : routine laboratory and dengue-specific
laboratory
Step II. Diagnosis, assessment of disease phase and severity
Step III. Management
Disease notification
Management decisions. Depending on the clinical
manifestations and other circumstances, patients may:
– be sent home (Group A);
– be referred for in-hospital management (Group B);
– require emergency treatment and urgent referral (Group C).
37.
38. Groups A-Patients who are sent
home
• Encourage plenty of oral fluids
• Inform about the warning signs
• Paracetamol for high fever. Never aspirin,ibuprofen or
other NSAIDS
41. Algorithm for fluid management in compensated shock
Compensated shock (SBP maintained but has signs of reduced perfusion)
Fluid resuscitation with isotonic crystalloid 5–10 ml/kg/hr over 1 hour
Improvement
NO
YES
Check HCT
IV crystalloid 5–7 ml/kg/hr for 1–2 HCT↑ or high HCT↓
hours, then:
reduce to 3–5 ml/kg/hr for 2–4 hours; Administer 2nd bolus of fluid Consider significant
reduce to 2–3 ml/kg/hr for 2–4 hours. 10–20 ml/kg/hr for 1 hour occult/overt bleed
Initiate transfusion
If patient continues to improve, fluid can be Improvement with fresh whole
further reduced. blood
Monitor HCT 6–8 hourly.
YES NO
If the patient is not stable, act according
to HCT levels:
If patient improves,
if HCT ↑, consider bolus fluid administration
reduce to 7–10 ml/kg/hr
or increase fluid administration;
for 1–2 hours
if HCT ↓, consider transfusion with fresh
Then reduce further
whole transfusion.
Stop at 48 hours.
42. Algorithm for fluid management in hypotensive shock
Hypotensive shock Fluid resuscitation with 20 ml/kg isotonic crystalloid or colloid over 15 minutes.
Try to obtain a HCT level before fluid resuscitation
Improvement
YES NO
Review 1st HCT
Crystalloid/colloid 10 ml/kg/hr for 1 hour, HCT↓
then continue with: HCT↑ or high
IV crystalloid 5–7 ml/kg/hr for 1– 2 hours; Administer 2nd bolus fluid (colloid) Consider significant
reduce to 3–5 ml/kg/hr for 2–4 hours; 10–20 ml/kg over ½-1 hour occult/overt bleed
reduce to 2–3 ml/kg/hr for 2–4 hours. Initiate transfusion with
Improvement fresh whole blood
If patient continues to improve, fluid can be
further reduced.
YES NO
Monitor HCT 6-hourly. Repeat 2nd HCT
If the patient is not stable, act according
HCT↑ or high HCT↓
to HCT levels:
if HCT ↑, consider bolus fluid administration
Administer 3rd bolus fluid (colloid)
or increase fluid administration;
10–20 ml/kg over 1 hour
if HCT ↓, consider transfusion with fresh
whole transfusion.
Improvement
Stop at 48 hours.
YES NO
Repeat 3rd HCT
43. Treatment of hemorrhagic
complications
● Mucosal bleeding :
if patient remains stable with fluid resuscitation/replacement,
considered as minor
● Bleeding improves rapidly during recovery phase
● Patients with profound thrombocytopenia :
strict bed rest and protect from trauma
not give i.m injections (avoid hematoma)
prophylactic platelet transfusions for severe thrombocytopaenia in
hemodynamically stable patients not shown to be effective and not
necessary
44. Management of Dengue Infection
● No hemorrhagic manifestations and patient is well-
hydrated:
home treatment
● Hemorrhagic manifestations or hydration borderline:
outpatient observation center or hospitalization
● Warning signs (even without profound shock) or
DSS:
hospitalize
45. Treatment of Dengue Fever
● Fluids
● Rest
● Antipyretics (avoid aspirin and NSAIDs)
● Monitor blood pressure, hematocrit, platelet
count, level of consciousness
Editor's Notes
- Grade I มีไข้และมีอาการร่วมอื่นๆแต่ไม่จำเพาะ แต่เมื่อทำ tourniquet test จะให้ผล positive - Grade II อาการเหมือน grade I แต่ที่เพิ่มเติมคือ พบเลือดออกเป็นจุดเลือดใต้ผิวหนัง - Grade III ระบบไหลเวียนโลหิตเริ่มล้มเหลวเกิดอาการช็อค ชีพจรเร็ว เบา pulse pressure แคบ ความดันโลหิตต่ำ ริมฝีปากเขียว ตัวเย็น กระสับกระส่าย - Grade IV แสดงอาการช็อครุนแรง ความดันโลหิตและชีพจรวัดไม่ได้
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- Grade I มีไข้และมีอาการร่วมอื่นๆแต่ไม่จำเพาะ แต่เมื่อทำ tourniquet test จะให้ผล positive - Grade II อาการเหมือน grade I แต่ที่เพิ่มเติมคือ พบเลือดออกเป็นจุดเลือดใต้ผิวหนัง - Grade III ระบบไหลเวียนโลหิตเริ่มล้มเหลวเกิดอาการช็อค ชีพจรเร็ว เบา pulse pressure แคบ ความดันโลหิตต่ำ ริมฝีปากเขียว ตัวเย็น กระสับกระส่าย - Grade IV แสดงอาการช็อครุนแรง ความดันโลหิตและชีพจรวัดไม่ได้
dengue infection is defined as primary if IgM/IgG OD ratio > 1.2 (using pt’s sera at 1/100 dilution) or 1.4 (using pt’s sera at 1/20 dilutions) secondary if ratio <1.2 or 1.4 Ratios : vary between lab