This document provides information about dengue virus and dengue hemorrhagic fever. It discusses how dengue virus is transmitted by Aedes aegypti mosquitoes. It describes the four serotypes of dengue virus and their ability to cause immunity and disease. The clinical manifestations of dengue fever and dengue hemorrhagic fever are outlined, including the grades of dengue hemorrhagic fever. Risk factors for severe dengue and the pathogenesis of dengue hemorrhagic fever are also summarized.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
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.
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
dengue-130319003111-phpapp01.pdf
1. Dr. Sachin Verma MD, FICM, FCCS, ICFC
Dr. Sachin Verma MD, FICM, FCCS, ICFC
Fellowship in Intensive Care Medicine
Fellowship in Intensive Care Medicine
Infection Control Fellows Course
Infection Control Fellows Course
Consultant Internal Medicine and Critical Care
Consultant Internal Medicine and Critical Care
Web:-
Web:- http://www.medicinedoctorinchandigarh.com
http://www.medicinedoctorinchandigarh.com
Mob:- +91-7508677495
Mob:- +91-7508677495
References;
References;
1.
1. Harrison
Harrison´s
´s principle of internal medicine -16
principle of internal medicine -16th
th
ed
ed
2.
2. Park
Park´s textbook of preventive and social medicine -17
´s textbook of preventive and social medicine -17th
th
ed
ed
3.
3. www.cdc.org
www.cdc.org
3. Virus vector and transmission
Virus vector and transmission
Dengue Virus
Dengue Virus
Causes dengue and dengue hemorrhagic fever
Causes dengue and dengue hemorrhagic fever
Is an arbovirus
Is an arbovirus
Transmitted by mosquitoes
Transmitted by mosquitoes
Composed of single-stranded RNA
Composed of single-stranded RNA
Has 4 serotypes (DEN-1, 2, 3, 4)
Has 4 serotypes (DEN-1, 2, 3, 4)
4. Dengue Viruses
Dengue Viruses
Each serotype provides specific lifetime
Each serotype provides specific lifetime
immunity, and short-term cross-immunity
immunity, and short-term cross-immunity
All serotypes can cause severe and fatal
All serotypes can cause severe and fatal
disease
disease
Genetic variation within serotypes
Genetic variation within serotypes
Some genetic variants within each serotype
Some genetic variants within each serotype
appear to be more virulent or have greater
appear to be more virulent or have greater
epidemic potential
epidemic potential
5. Aedes aegypti
Aedes aegypti
Dengue transmitted by
Dengue transmitted by
infected female mosquito
infected female mosquito
Primarily a daytime feeder
Primarily a daytime feeder
Lives around human
Lives around human
habitation
habitation
Lays eggs and produces
Lays eggs and produces
larvae preferentially in
larvae preferentially in
artificial containers.
artificial containers.
Diseases- yellow fever, filaria
Diseases- yellow fever, filaria
dengue, chikungunya fever,
dengue, chikungunya fever,
rift valley fever.
rift valley fever.
7. Model of baseline transmission
Model of baseline transmission
potential (1961-1990 climate)
potential (1961-1990 climate)
8. Model of future transmission
Model of future transmission
potential (2080s climate)
potential (2080s climate)
9. Population increase only
Population increase only
Population at
Population at
risk (billions)
risk (billions)
% of total
% of total
population
population
2050s
2050s 3.2
3.2 34
34
2080s
2080s 3.5
3.5 35
35
Population increase plus
Population increase plus
climate change (HADCM2)
climate change (HADCM2)
2050s
2050s 4.1
4.1 44
44
2080s
2080s 5.2
5.2 52
52
10. Replication and Transmission
Replication and Transmission
of Dengue Virus
of Dengue Virus
1. Virus transmitted
to human in mosquito
saliva
2. Virus replicates
in target organs
3. Virus infects white
blood cells and
lymphatic tissues
4. Virus released and
circulates in blood
3
4
1
2
11. Replication and Transmission
Replication and Transmission
of Dengue Virus
of Dengue Virus
5. Second mosquito
ingests virus with blood
6. Virus replicates
in mosquito midgut
and other organs,
infects salivary
glands
7. Virus replicates
in salivary glands
6
7
5
12. Transmission of Dengue Virus
Transmission of Dengue Virus
by
by Aedes aegypti
Aedes aegypti
Viremia Viremia
Extrinsic
incubation
period
DAYS
0 5 8 12 16 20 24 28
Human #1 Human #2
Illness
Mosquito feeds /
acquires virus
Mosquito refeeds /
transmits virus
Intrinsic
incubation
period
Illness
13. Clinical Manifestations of Dengue and
Clinical Manifestations of Dengue and
Dengue Hemorrhagic Fever
Dengue Hemorrhagic Fever
Undifferentiated fever
Undifferentiated fever
Classic dengue fever
Classic dengue fever
Dengue hemorrhagic fever
Dengue hemorrhagic fever
Dengue shock syndrome
Dengue shock syndrome
14. Undifferentiated Fever
Undifferentiated Fever
May be the most common manifestation of
May be the most common manifestation of
dengue
dengue
Prospective study found that 87% of patients
Prospective study found that 87% of patients
infected were either asymptomatic or only mildly
infected were either asymptomatic or only mildly
symptomatic
symptomatic
Other prospective studies including all age-
Other prospective studies including all age-
groups also demonstrate silent transmission.
groups also demonstrate silent transmission.
15. Clinical Characteristics
Clinical Characteristics
of Dengue Fever
of Dengue Fever
Fever
Fever
Headache
Headache
Muscle and joint pain
Muscle and joint pain
Nausea/vomiting
Nausea/vomiting
Rash
Rash
Hemorrhagic manifestations
Hemorrhagic manifestations
17. Signs and Symptoms of
Signs and Symptoms of
Encephalitis/Encephalopathy
Encephalitis/Encephalopathy
Associated with Acute Dengue
Associated with Acute Dengue
Infection
Infection
Decreased level of consciousness:
Decreased level of consciousness:
lethargy, confusion, coma
lethargy, confusion, coma
Seizures
Seizures
Nuchal rigidity
Nuchal rigidity
Paresis
Paresis
18. Clinical Case Definition for
Clinical Case Definition for
Dengue Hemorrhagic Fever
Dengue Hemorrhagic Fever
Fever, or recent history of acute fever
Fever, or recent history of acute fever
Hemorrhagic manifestations
Hemorrhagic manifestations
Low platelet count (100,000/mm
Low platelet count (100,000/mm3
3
or less)
or less)
Objective evidence of “leaky capillaries:”
Objective evidence of “leaky capillaries:”
– elevated hematocrit (20% or more over
elevated hematocrit (20% or more over
baseline)
baseline)
– low albumin
low albumin
– pleural or other effusions
pleural or other effusions
4 Necessary Criteria:
4 Necessary Criteria:
19. Four Grades of DHF
Four Grades of DHF
Grade 1
Grade 1
– Fever and nonspecific constitutional symptoms
Fever and nonspecific constitutional symptoms
– Positive tourniquet test is only hemorrhagic
Positive tourniquet test is only hemorrhagic
manifestation
manifestation
Grade 2
Grade 2
– Grade 1 manifestations + spontaneous bleeding
Grade 1 manifestations + spontaneous bleeding
Grade 3
Grade 3
– Signs of circulatory failure (rapid/weak pulse, narrow
Signs of circulatory failure (rapid/weak pulse, narrow
pulse pressure, hypotension, cold/clammy skin)
pulse pressure, hypotension, cold/clammy skin)
Grade 4
Grade 4
– Profound shock (undetectable pulse and BP)
Profound shock (undetectable pulse and BP)
20. Danger Signs in
Danger Signs in
Dengue Hemorrhagic Fever
Dengue Hemorrhagic Fever
Abdominal pain - intense and sustained
Abdominal pain - intense and sustained
Persistent vomiting
Persistent vomiting
Abrupt change from fever to
Abrupt change from fever to
hypothermia, with sweating and
hypothermia, with sweating and
prostration
prostration
Restlessness or somnolence
Restlessness or somnolence
21. Clinical Case Definition for Dengue
Clinical Case Definition for Dengue
Shock Syndrome
Shock Syndrome
4 criteria for DHF
4 criteria for DHF
Evidence of circulatory failure manifested
Evidence of circulatory failure manifested
indirectly by all of the following:
indirectly by all of the following:
– Rapid and weak pulse
Rapid and weak pulse
– Narrow pulse pressure (
Narrow pulse pressure (≤ 20 mm Hg)
20 mm Hg) OR
OR
hypotension for age
hypotension for age
– Cold, clammy skin and altered mental
Cold, clammy skin and altered mental
status
status
Frank shock is direct evidence of circulatory
Frank shock is direct evidence of circulatory
failure
failure
22. Risk Factors Reported for DHF
Risk Factors Reported for DHF
Virus strain :
Virus strain :DHF risk is greatest for DEN-2, followed
DHF risk is greatest for DEN-2, followed
by DEN-3, DEN-4 and DEN-1
by DEN-3, DEN-4 and DEN-1
Pre-existing anti-dengue antibody
Pre-existing anti-dengue antibody
– previous infection
previous infection
– maternal antibodies in infants
maternal antibodies in infants
Host genetics-females more affected,
Host genetics-females more affected,
malnutrition protective.
malnutrition protective.
Age(<12)
Age(<12)
23. Unusual Presentations
Unusual Presentations
of Severe Dengue Fever
of Severe Dengue Fever
Encephalopathy
Encephalopathy
Hepatic damage
Hepatic damage
Cardiomyopathy
Cardiomyopathy
Severe gastrointestinal hemorrhage
Severe gastrointestinal hemorrhage
24. Increased Probability of DHF
Increased Probability of DHF
Hyperendemicity
Increased circulation
of viruses
Increased probability
of secondary infection
Increased probability of
occurrence of virulent strains
Increased probability of
immune enhancement
Increased probability of DHF
25. Neutralizing antibody to Dengue 1 virus
1
1
Dengue 1 virus
1
Pathogenesis of DHF
Pathogenesis of DHF
STEP 1- Homologous Antibodies Form Non-
STEP 1- Homologous Antibodies Form Non-
infectious Complexes
infectious Complexes
Non-neutralizing antibody
1
1 Complex formed by neutralizing antibody and virus
26. Non-neutralizing antibody to Dengue 1 virus
Dengue 2 virus
2 2
2
2
2
STEP2- Heterologous Antibodies of first
STEP2- Heterologous Antibodies of first
serotype infection form Infectious Complexes
serotype infection form Infectious Complexes
with second serotype
with second serotype
Complex formed by non-neutralizing antibody
and virus
2
27. 2
2
2
2
2
2
2
2
2
2
STEP3 - Heterologous Complexes Enter More
STEP3 - Heterologous Complexes Enter More
Monocytes, Where Virus Replicates
Monocytes, Where Virus Replicates
Non-neutralizing antibody
Dengue 2 virus
2
Complex formed by non-neutralizing
antibody and Dengue 2 virus
2
28. STEP4 –DHF pathogenesis
STEP4 –DHF pathogenesis
Infected monocytes release vasoactive
Infected monocytes release vasoactive
mediators, resulting in increased vascular
mediators, resulting in increased vascular
permeability and hemorrhagic manifestations
permeability and hemorrhagic manifestations
that characterize DHF and DSS
that characterize DHF and DSS
29. Clinical Evaluation in Dengue Fever
Clinical Evaluation in Dengue Fever
Blood pressure
Blood pressure
Evidence of bleeding in skin or other sites
Evidence of bleeding in skin or other sites
Hydration status
Hydration status
Evidence of increased vascular
Evidence of increased vascular
permeability-- pleural effusions, ascites
permeability-- pleural effusions, ascites
Tourniquet test
Tourniquet test
31. Tourniquet Test
Tourniquet Test
Inflate blood pressure
Inflate blood pressure
cuff to a point midway
cuff to a point midway
between systolic and
between systolic and
diastolic pressure for 5
diastolic pressure for 5
minutes
minutes
Positive test: 20 or more
Positive test: 20 or more
petechiae per 1 inch
petechiae per 1 inch2
2
(6.25 cm
(6.25 cm2
2
)
)
32. Laboratory Tests
Laboratory Tests
in Dengue Fever
in Dengue Fever
Clinical laboratory tests
Clinical laboratory tests
– CBC--WBC, platelets, hematocrit
CBC--WBC, platelets, hematocrit
– Albumin
Albumin
– Liver function tests
Liver function tests
– Urine--check for microscopic hematuria
Urine--check for microscopic hematuria
Dengue-specific tests
Dengue-specific tests
– Virus isolation
Virus isolation
– Serology
Serology
33. Laboratory Methods for Dengue Diagnosis-
Laboratory Methods for Dengue Diagnosis-
Virus isolation to determine serotype of
Virus isolation to determine serotype of
the infecting virus
the infecting virus
IgM ELISA test for serologic diagnosis
IgM ELISA test for serologic diagnosis
34. Virus isolation: cell culture, mosquito inoculation&
Virus isolation: cell culture, mosquito inoculation&
fluroscent antibody test
fluroscent antibody test
36. Collection and Processing of
Collection and Processing of
Samples for Laboratory
Samples for Laboratory
Diagnosis
Diagnosis
Type of
Specimen
Time of
Collection
Type of
Analysis
Acute-phase
blood
(0-5 days after onset)
When patient presents;
collect second sample
during convalescence
Virus isolation
and/or serology
Convalescent-phase
blood
(≥ 6 days after onset)
Between days 6 and 21
after onset
Serology
37. Temperature, Virus Positivity
Temperature, Virus Positivity
and Anti-Dengue IgM , by
and Anti-Dengue IgM , by
Fever Day
Fever Day
Dengue IgM
Mean Max. Temperature Virus
Fever Day
0
20
40
60
80
100
Percent
Virus
Positive
-4 -3 -2 -1 0 1 2 3 4 5 6
39.5
39.0
38.5
38.0
37.5
37.0
Temperature
(degrees
Celsius)
Dengue
IgM
(EIA
units)
300
150
0
75
225
38. Management of dengue fever
Management of dengue fever
Outpatient Triage
Outpatient Triage
No hemorrhagic manifestations and patient is
No hemorrhagic manifestations and patient is
well-hydrated:
well-hydrated: home treatment
home treatment
Hemorrhagic manifestations or hydration
Hemorrhagic manifestations or hydration
borderline:
borderline: outpatient observation center or
outpatient observation center or
hospitalization
hospitalization
Warning signs (even without profound shock) or
Warning signs (even without profound shock) or
DSS:
DSS: hospitalize
hospitalize
39. Warning Signs for Dengue Shock
Warning Signs for Dengue Shock
When Patients Develop DSS:
• 3 to 6 days after onset of
symptoms
When Patients Develop DSS:
• 3 to 6 days after onset of
symptoms
Initial Warning Signals:
• Disappearance of fever
• Drop in platelets
• Increase in hematocrit
Initial Warning Signals:
• Disappearance of fever
• Drop in platelets
• Increase in hematocrit
Alarm Signals:
• Severe abdominal pain
• Prolonged vomiting
• Abrupt change from fever
to
hypothermia
• Change in level of
consciousness (irritability
or
Alarm Signals:
• Severe abdominal pain
• Prolonged vomiting
• Abrupt change from fever
to
hypothermia
• Change in level of
consciousness (irritability
or
somnolence)
Four Criteria for DHF:
• Fever
• Hemorrhagic manifestations
• Excessive capillary permeability
• ≤ 100,000/mm3
platelets
Four Criteria for DHF:
• Fever
• Hemorrhagic manifestations
• Excessive capillary permeability
• ≤ 100,000/mm3
platelets
40. Treatment of Dengue Fever
Treatment of Dengue Fever
Fluids
Fluids
Rest
Rest
Antipyretics (avoid aspirin and non-
Antipyretics (avoid aspirin and non-
steroidal anti-inflammatory drugs)
steroidal anti-inflammatory drugs)
Monitor blood pressure, hematocrit,
Monitor blood pressure, hematocrit,
platelet count, level of consciousness
platelet count, level of consciousness
41. Treatment of Dengue Fever
Treatment of Dengue Fever
Continue monitoring after defervescence
Continue monitoring after defervescence
If any doubt, provide intravenous fluids, guided
If any doubt, provide intravenous fluids, guided
by serial hematocrits, blood pressure, and urine
by serial hematocrits, blood pressure, and urine
output
output
The volume of fluid needed is similar to the
The volume of fluid needed is similar to the
treatment of diarrhea with mild to moderate
treatment of diarrhea with mild to moderate
isotonic dehydration (5%-8% deficit)
isotonic dehydration (5%-8% deficit)
42. Rehydrating Patients Over 40 kg
Rehydrating Patients Over 40 kg
Volume required for rehydration is
Volume required for rehydration is twice
twice the
the
recommended maintenance requirement
recommended maintenance requirement
Formula for calculating maintenance volume:
Formula for calculating maintenance volume:
1500 + 20 x (weight in kg - 20)
1500 + 20 x (weight in kg - 20)
For example, maintenance volume for 55 kg
For example, maintenance volume for 55 kg
patient is: 1500 + 20 x (55-20) = 2200 ml
patient is: 1500 + 20 x (55-20) = 2200 ml
For this patient, the rehydration volume would
For this patient, the rehydration volume would
be 2 x 2200, or 4400 ml.
be 2 x 2200, or 4400 ml.
43. Treatment of Dengue Fever
Treatment of Dengue Fever
Avoid invasive procedures when
Avoid invasive procedures when
possible
possible
Unknown if the use of steroids,
Unknown if the use of steroids,
intravenous immune globulin, or platelet
intravenous immune globulin, or platelet
transfusions to shorten the duration or
transfusions to shorten the duration or
decrease the severity of
decrease the severity of
thrombocytopenia is effective
thrombocytopenia is effective
Patients in shock may require treatment
Patients in shock may require treatment
in an intensive care unit
in an intensive care unit
44. Indications for Hospital
Indications for Hospital
Discharge
Discharge
Absence of fever for 24 hours (without
Absence of fever for 24 hours (without
anti-fever therapy) and return of appetite
anti-fever therapy) and return of appetite
Visible improvement in clinical picture
Visible improvement in clinical picture
Stable hematocrit
Stable hematocrit
3 days after recovery from shock
3 days after recovery from shock
Platelets
Platelets ≥ 50,000/mm
50,000/mm3
3
No respiratory distress from pleural
No respiratory distress from pleural
effusions/ascites
effusions/ascites
45. Common Misconceptions about
Common Misconceptions about
Dengue Hemorrhagic Fever
Dengue Hemorrhagic Fever
Dengue + bleeding = DHF
Dengue + bleeding = DHF
Need 4 WHO criteria, capillary permeability
Need 4 WHO criteria, capillary permeability
DHF kills only by hemorrhage
DHF kills only by hemorrhage
Patient dies as a result of shock
Patient dies as a result of shock
Poor management turns dengue into DHF
Poor management turns dengue into DHF
Poorly managed dengue can be more severe,
Poorly managed dengue can be more severe, but
but DHF is a
DHF is a
distinct condition, which even well-treated patients may
distinct condition, which even well-treated patients may
develop
develop
Positive tourniquet test = DHF
Positive tourniquet test = DHF
Tourniquet test is a nonspecific indicator of capillary
Tourniquet test is a nonspecific indicator of capillary
fragility
fragility
46. DHF is a pediatric disease
DHF is a pediatric disease
All age groups are involved in the
All age groups are involved in the
Americas
Americas
DHF is a problem of low income
DHF is a problem of low income
families
families
All socioeconomic groups are affected
All socioeconomic groups are affected
Tourists will certainly get DHF with a
Tourists will certainly get DHF with a
second infection
second infection
Tourists are at low risk to acquire DHF
Tourists are at low risk to acquire DHF
47. Vector Control Methods:
Vector Control Methods:
Chemical Control
Chemical Control
Larvicides (organophosphorus compounds –
Larvicides (organophosphorus compounds –
fenthion ,abate) may be used to kill immature
fenthion ,abate) may be used to kill immature
aquatic stages
aquatic stages
Ultra-low volume fumigation ineffective against
Ultra-low volume fumigation ineffective against
adult mosquitoes
adult mosquitoes
Mosquitoes may have resistance to commercial
Mosquitoes may have resistance to commercial
aerosol sprays
aerosol sprays
48. Vector Control Methods:
Vector Control Methods:
Biological and Environmental
Biological and Environmental
Control
Control
Biological control
Biological control
– Largely experimental
Largely experimental
– Option: place fish in containers to eat
Option: place fish in containers to eat
larvae
larvae
Environmental control
Environmental control
– Elimination of larval habitats
Elimination of larval habitats
– Most likely method to be effective in the
Most likely method to be effective in the
long term
long term
49. Purpose of Control
Purpose of Control
Reduce female vector density to a level
Reduce female vector density to a level
below which epidemic vector
below which epidemic vector
transmission will not occur
transmission will not occur
Based on the assumption that
Based on the assumption that
eliminating or reducing the number of
eliminating or reducing the number of
larval habitats in the domestic
larval habitats in the domestic
environment will control the vector
environment will control the vector
The minimum vector density to prevent
The minimum vector density to prevent
epidemic transmission is unknown
epidemic transmission is unknown