1) Dengue fever is caused by dengue virus transmitted by mosquitoes and has four distinct serotypes. It has an incubation period of 4-7 days and may present asymptomatically or with mild to severe symptoms.
2) The clinical course involves a febrile phase with symptoms like fever and rash, followed by a critical phase where vascular permeability increases, and a recovery phase. Shock may occur if plasma leakage is not corrected.
3) Hospital admission is recommended for patients exhibiting warning signs like abdominal pain, vomiting, bleeding, lethargy or clinical signs of shock, organ impairment, inability to tolerate fluids, or those with risk factors.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
- 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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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
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.
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.
3. Introduction and epidemiology
• Dengue infection is caused by dengue virus which is a mosquito-
borne flavivirus. It is transmitted by Aedes aegypti and Aedes
albopictus. There are four distinct serotypes, DENV-1,2,3 and 4.
• The incubation period for dengue infection is 4-7 days. It may be
asymptomatic or may result in a spectrum of illness ranging from
undifferentiated mild febrile illness to severe disease, with or without
plasma leakage and organ impairment.
4.
5. CLINICAL COURSE OF DENGUE INFECTION
5
Incubation period : 4 - 7 days (range 3 -
14 days)
After the incubation period, the illness
begins abruptly.
Febrile phase : 2 - 7 days. Commences at
symptom onset
Critical phase : Usually after D3 of fever
(maybe earlier). Commences around time
of defervescence*. Coincides with
increase in capillary permeability. Lasts
24 - 48 hours.
* Definition : Body temperature <38
degrees & remains below this level.
Recovery phase : Reabsorption of
extravascular fluid.
6. FEBRILE PHASE
6
Viraemia : Fever, headache, N&V,
flushing, myalgia, joint pain, rash,
retro-orbital pain, mild haemorrhage
(petechial, mucosal bleed)
Progressive decrease in total white
cell count followed by platelet
reduction
Haematocrit
male < 60 years – 46%
male > 60 years – 42%
female (all age groups) – 40%
7. Increase vascular permeability:
third space loss, organ
dysfunction
*Leukopenia with relative
lymphocytosis
*Haemoconcentration
*Thrombocytopenia
Prolonged APTT
AST > ALT
CRITICAL PHASE
7
8. The primary pathophysiological abnormality seen in dengue infection is an acute increase in
vascular permeability that leads to plasma leakage, resulting in haemoconcentration and
hypovolaemia or shock.
Hypovolaemia leads to reflex tachycardia and generalised vasoconstriction due to increased
sympathetic output. Clinical manifestations of vasoconstriction in various systems are as
follows:
• Skin - coolness, pallor and delayed capillary refill time
• Cardiovascular system - raised diastolic blood pressure and narrowing of pulse pressure
• Renal system - reducing urine output
• Gastrointestinal system - persistent vomiting, persistent diarrhoea andabdominal pain
• Central nervous system – lethargy, restlessness, apprehension,reduced level of consciousness
• Respiratory system – tachypnoea (respiratory rate >20/min)
Inadequate perfusion of the tissue leads to increased anaerobic glycolys is and lactic acidosis.
If the hypovolaemia is not corrected promptly, the patient will progress to a refractory shock
state. By then, the tissue perfusion would not respond to vasopressor drugs, even if the
bloodpressure and intravascular volume were to be restored and cardiac output would remain
depressed. The resultant lactic acidosis further depresses the myocardium and worsens the
hypotension.
The common late complications of prolonged shock are massive bleeding , disseminated
intravascular coagulopathy (DIC) and multi-organ failure which are often fatal.
9. Classical rash of “isles of
white in the sea of red” with
generalised pruritus
*HCT level stabilises and
drops further due to
haemodilution
*Recovery of white cell
count (WCC).
* Recovery of platelet count
RECOVERY PHASE
9
12. CLINICAL HISTORY
Date of onset of fever
Assess warning signs (last BO/Vomit)
*Oral intake : quantity and quality ? >1.5L/day
*Urine output : frequency, volume & time of
most recent voiding (last PU)? <6hours
What activities could do patient do during the
febrile illness ? ADL independent, no MC
Change in mental state/seizure/dizziness
Other important relevant histories :
Family or neighbourhood history of dengue or travel to dengue
endemic area
Jungle trekking and swimming in waterfall ( DD:
leptospirosis/malaria/typhus)
Recent unprotected sexual or IVDU (DD : acute HIV
seroconversion illness)
Co-morbidities (DD : sepsis particularly in diabetes mellitus)
Medications : *anticoagulants/antiplatelet NSAIDS,
OTC/traditional meds/IM injections/anti-HPT/all meds with last
time taken
*Risk factors: pregnancy, obesity, diabetes mellitus,
hypertension, IHD, coagulopathy, renal failure, CLD, COPD.
Age>65yo.
*Social factors that limit follow up blood ix
12
13. CLINICAL EXAMINATION
Assess consciousness GCS
Assess hydration: eye, lip, tongue, skin turgor
Assess haemodynamic:
CCTVR
BP
Pulse pressure (>20mmHg)
Urine output (>0.5ml/kg/hr, not concentrated)
Look for tachypnoea / acidotic breathing / pleural
effusion
Check for abdominal tenderness / hepatomegaly /
ascites
Abdominal pain in febrile phase: omentum
ischaemia due to dehydration
Abdominal pain in critical phase: acute stretch of
liver capsule
Abdominal pain in recovery phase: ascites
Examine for bleeding tendency
Petechiae
Purpura
Ecchymoses
Malaena
Bleeding gingiva
Epistaxis
13
Tourniquet
test
14. INVESTIGATIONS
Disease monitoring tests
FBC: Thrombocytopenia, leucopenia, inc HCT
Coagulation profile
RP/ LFT
Lactate
Blood gases
Special test: CK
Diagnostic test
rapid combo test
dengue antigen and serology test by ELISA
NS1 antigen & IgM/IgG antibodies
Dengue viral RNA detection
15.
16.
17. DIAGNOSTIC INVESTIGATION
Dengue NS1 antigen test and rapid
combo tests (NS1 antigen and
dengue IgM/IgG antibodies)
Interpret within 15-20 minutes
Invalid after 20 minutes
sensitivity 93.9%; specificity 92%
Dengue Viral RNA Detection (Real
time RT PCR)
Determine Dengue serotype
Virus isolation
- NS1 Antigen : sensitivity drop day
4-5. In defervescence, usually non-
detectable. If present >D5, predict
severe dengue.
False positive in Yellow Fever.
- IgM : >D5 of illness, peaks about
2/52 then wanes down over 1 hour.
-IgG : after Day 7. Check titre. If 1 :
2560, indicate of secondary dengue
False positive in JE, malaria,
leptospirosis, toxoplasmosis,
syphilis, RA 17
18. DISEASE MONITORING INVESTIGATION
Identify phase of dengue
TWC, HCT, Platelet
Markers of plasma leakage
and hypovoleamia
HCT (haemoconcentration),
VBG (metabolic acidosis),
lactate (adaequate<2
mmol/L)
Complication (when in suspect severe dengue)
Hepatitis: AST or ALT >=1000 (AST>ALT)
Coagulopathy: Coagulation profile (prolonged
APTT)
Acute renal failure: UFEME, Renal profile (RP)
Myocarditis: Troponin and Creatine Kinase (CK),
Echo, ECG
Myositis: CK
Pleural effusion: CXR, US Thorax
Ascites / gallbladder wall edema: US Abdomen
Neurological (Encephalopathy/encephalitis): CT
Brain, Lumbar puncture
18
19. Diagnosis: Dengue fever D? of illness (point taken @time date), in ? Phase with/without warning
signs of ?, currently hemodynamically stable/resolved compensated shock. 19
20.
21. CRITERIA FOR HOSPITAL ADMISSION AND REFERRAL
!! Decision for referral and admission must not be basesd on a single clinical parameter but should depend on the
TOTAL ASSESSMENT of the patient.
SYMPTOMS
a.Warning signs
b.Bleeding manifestations
c.Inability to tolerate oral fluids
d.Reduced urine output
e.Seizure
SIGNS
a.Dehydration
b.Shock
c.Bleeding
d.Any organ failure
SPECIAL SITUATION
a.Patients with comorbidities as diabetes, HPT, IHD, Coagulopathy, Morbid Obesity, Renal Failure, Chronic Liver
disease , COPD
b.Elderly mor than 65 years old
c.Patients who are on anti platelet and anti coagulant.
d.Pregnancy
e.Social factors that limit follow up as living far from health facility, no transport or living alone.
LAB CRITERIA
a.Rising HCT with reduced platelet count
22. FLUID MANAGEMENT
1. Is the haemodynamic status stable or compromised?
2. Which phase of disease?
3. Can the patient tolerate orally well?
4. Is there a warning sign?
5. What is the aim for fluid therapy?
22
Common pitfalls in fluid therapy:warning signs as the sole parameter without considering other
clinical parameters.
Treating patients with unnecessary fluid boluses based on raised HCT or
Excessive and prolonged fixed fluid regime in stable patients.
Infrequent monitoring and adjustment of infusion rate.
Continuation of intravenous fluid during the recovery phase.
Excessive fluid therapy in patients with co-morbidities (such as heart disease and renal
disease)
23. NON SHOCK STABLE
PATIENT
23
• Encourage oral fluid intake
• 2-3L daily, and 1.2-1.5 times the normal
maintenance during the critical phase for
dengue patient without comorbidities).
• IV fluid (0.9% saline is recommended) is
indicated for(asmaintainancefluid)
• increasing HCT with evidence of ongoing
plasma leakage, despite increased oral
intake
• Vomiting, unable to tolerate oral fluid,
severe diarrhoea
• Review infusion rate within 2-4 hours (IO
chart monitoring)
24. PATIENT WITH PERSISTENT WARNING
SIGNS WITH INCREASING OR
PERSISTENTLY HIGH HCT
Graded bolus fluid regime
Frequent monitoring of
clinical and laboratory
parameters every 2-4 hours
until patients improve.
Aim for urine output of 0.5-
1.0 ml/kg/hr.
24
26. GRADE OF DENGUE SHOCK
SYNDROME
⚫ Grade l : Fever accompanied by non-specific constitutional
symptoms; the only haemorrhagic manifestation is a positive
tourniquet test and / or easy bruising.
⚫ Grade ll : Spontaneous bleeding, in addition to the manifestations
of Grade l patients, usually in the form of skin or other
haemorrhages.
⚫ Grade lll : Circulatory Failure manifested by a rapid, weak pulse
and narrowing of pulse pressure or hypotension with the presence
of cold, clammy skin and restlessness.
⚫ Grade lV: Profound shock with undetectable blood pressure or
pulse.
28. NON RESPONDER TO INITIAL
RESUSCITATION
If the first two cycles off fluid resuscitation (40cc/kg) fails to establish stable
haemodynamically and HCT remains high the 3rd cycle colloid should be
considered.
If the repeated HCT drops but clinically patient still in shock we must suspect of
significant bleed (occultbleed).
Other possible causes of persistent shockare:
-sepsis , cardiogenic shock (due to myocarditis ,RV / LV dysfuction , pericardial
effusion or cardiac ischaemia ) , cytokine storm , liver failure with lactic acidosis.
32. MANAGEMENT OF SIGNIFICANT OCCULT BLEEDING
⚫ Transfuse blood (5-10 ml/kg of packed red cells) and
observe the clinical response. Consider blood
components if required
⚫ Consider repeating the blood transfusion if there is
further blood loss or no appropriate rise in HCT acter
blood transfusion
⚫ Endoscopy by trained surgeon or gastroenterologist is
indicated if these patients have persistent bleeding
despite optimum medical therapy
33. DISCHARGE CRITERIA
⚫ Afebrile for 48 hours
⚫ Improved general condition
⚫ Improved apetite
⚫ Stable hematocrit
⚫ Rising platlet count
⚫ No dyspnoea or respiratory distress from
plural effusion or ascites
⚫ Resolve bleeding episodes
⚫ Resolution or recovery of organ dysfunction