This document provides information on the epidemiology of dengue fever. It describes how dengue virus is an RNA virus transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Dengue causes a spectrum of disease from a self-limiting fever to severe dengue hemorrhagic fever. Factors like virus strain, vector density, human susceptibility, and environmental conditions determine outbreaks. Clinical manifestations range from asymptomatic infection to classic dengue fever symptoms to potentially fatal dengue hemorrhagic fever.
Arthropods form a major group of disease vectors with mosquitoes, flies, sand flies, lice, fleas, ticks and mites transmitting a huge number of diseases.
Many such vectors are haematophagous, which feed on blood at some or all stages of their lives.
Chikungunya is an epidemic disease, broke out in Bangladesh in 2017. It was first identified in Tanzania 1953. From then it continuously rose as an epidemic disease after some interval in Asia, Africa and even in America.
National Vector Borne Disease Control Programme (NVBDCP)Vivek Varat
The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of malaria and other vector borne diseases. Under the programme, it is ensured that the disadvantaged and marginalised sections benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission goals are achieved. The Directorate of NVBDCP under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, is the nodal agency responsible for planning, coordination, implementation, monitoring and evaluation of NVBDCP programme at all levels.
Kyasanur forest disease, KFD is a febrile disease associated with haemorrhage caused by kyasanur forest disease virus, a member of virus family of arbovirus & flavivirus and transmitted to man by bite of infected ticks.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
Tuberculosis infection is very common in the world and the disease manifest when ever either the virulence of the organism increases or the resistance of the host goes down.it can affect any part of the body.the best method of control of tuberculosis is early diagnosis and treatment.despite international cooperation the problem of resistance in tuberculosis is increasing and great efforts are being made to tackle this problem both in diagnostic tools as well as in treatment modalities. the social factors also play a big role in the causation as well as emergence of resistance is concerned . a participatory approach is required to combat the problem.
Arthropods form a major group of disease vectors with mosquitoes, flies, sand flies, lice, fleas, ticks and mites transmitting a huge number of diseases.
Many such vectors are haematophagous, which feed on blood at some or all stages of their lives.
Chikungunya is an epidemic disease, broke out in Bangladesh in 2017. It was first identified in Tanzania 1953. From then it continuously rose as an epidemic disease after some interval in Asia, Africa and even in America.
National Vector Borne Disease Control Programme (NVBDCP)Vivek Varat
The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of malaria and other vector borne diseases. Under the programme, it is ensured that the disadvantaged and marginalised sections benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission goals are achieved. The Directorate of NVBDCP under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, is the nodal agency responsible for planning, coordination, implementation, monitoring and evaluation of NVBDCP programme at all levels.
Kyasanur forest disease, KFD is a febrile disease associated with haemorrhage caused by kyasanur forest disease virus, a member of virus family of arbovirus & flavivirus and transmitted to man by bite of infected ticks.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
Tuberculosis infection is very common in the world and the disease manifest when ever either the virulence of the organism increases or the resistance of the host goes down.it can affect any part of the body.the best method of control of tuberculosis is early diagnosis and treatment.despite international cooperation the problem of resistance in tuberculosis is increasing and great efforts are being made to tackle this problem both in diagnostic tools as well as in treatment modalities. the social factors also play a big role in the causation as well as emergence of resistance is concerned . a participatory approach is required to combat the problem.
As an intern house officer, I prepared this presentation after I came across a rare case of dengue fever complicated by hemophagocytic lymphohistiocytosis (HLH). Dengue fever itself is a rare disease entity in the UAE, as a developed country; and the presence of such a complication merely added to the complexity of the diagnosis. Therefore, I am delighted to share this lively PowerPoint Presentation about dengue, which was initially supplemented with an interesting case presentation but was removed for confidentiality purposes when sharing the document. I hope you enjoy it!
PS: Use the slideshow button in Microsoft PowerPoint for the best experience.
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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 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
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.
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
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.
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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.
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
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5. • Is a single-stranded RNA viruses
that belong to the family
Flaviviridae and the genus
Flavivirus single-stranded RNA
viruses that belong to the family
Flaviviridae and the genus
Flavivirus
6. THE VECTOR
• Aedes aegypti and Aedes
Albopictus are the two most
important vectors of dengue.
8. • The symptom may be
asymptomatic or may lead to
classical dengue fever or dengue
haemorrhagic fever with shock
or dengue haemorrhagic fever
without shock.
13. AGENT
• The dengue virus belongs to a
distinct complex within the
genus flavivirus based on
antigenic and biological
characteristics.
14. • There are four virus serotypes
types which are designated as
DENV-1, DENV-2, DENV-3 and
DENV-4.
• Infection with any one serotype
confers a life long immunity to
that serotype.
15. VECTOR
• Aedes aegypti and Aedes
Albopictus are the two most
important vectors of dengue.
16. • Both the mosquitoes carry
vectorial competency for dengue
virus (high susceptibility
toinfecting virus, ability to
replicate the virus and ability to
transmit the virus to another
host.
17. • Aedes aegypti is a highly
domesticated, strongly
anthropophilic, nervous feeder(it
bites more than one host to
complete one blood meal)
18. • Also is a discordant species(it
needs more than one feed for
the completion of the genotropic
cycle).
• This habit results in the
generation of multiple cases in
the cities.
19. TRANSMISSION
• Aedes aegypti mosquito
becomes infective by feeding on
a patient from the day before
onset of the fifth day (viraemia
stage) of illness.
20. • After an extrinsic incubation
period of 8 to 10 days, the
mosquito becomes infective, and
is able to transmit the infection.
• Once the mosquito becomes
infective it remains so for life.
21.
22.
23.
24.
25. • The genital tract of the mosquito
gets infected and transovarian
transmission of dengue virus
occurs when enters fully
developed egg at the time of
oviposition.
40. • The failure of urban authorities
to provide civil amenities and
poor public health infrastructure
raises the potential for the
vector to breed at high level and
makes the environment
transmission conducive.
42. 1. Strain of the virus.
2. The density, behaviour and
vectorial capacity of the vector
population.
43. 3.The susceptibility of human
population.
4.The introduction of the virus
into the receptive community.
44. HIGH RISK PATIENTS
• Infants and elderly.
• Obesity.
• Pregnancy.
• Peptic ulcer disease.
45. • Women in mensturation who
have an abnormal bleeding.
• Haemolytic diseases.
• Congenital heart Diseases.
• Chronic diseases.
• Patients on steroids.
47. • Dengue virus infection may be
asymptomatic or may cause
undifferentiated febrile illness
(viral syndrome), dengue fever
(DF), Dengue haemorrhagic
Fever(DHF) including Dengue
Shock Syndrome(DSS).
49. UNDIFFERENCIATED FEVER
• Infants, children and adults who
have been infected with dengue
virus, especially for the first time
may develop a simple
undistinguishable fever from
other viral infection.
50. • Maculopapular rashes may
accompany the fever or may
appear during defervescence.
• Upper respiratory and
gastrointestinal symptoms are
common.
51. CLASSICAL DENGUE FEVER
• The illness is characterized by an
incubation period of 3 to 10 days
(commonly 5 to 6 days).
52. • The onset is sudden, with chills
and high fever, intense
headache, muscle and joint
pains which prevent all
movement.
53. • Within 24 hours retro-orbital
pain, particularly on eye
movements or eye pressure and
photophobia develops.
54. • Other symptoms include
extreme weakness, anoroxia,
constipation, altered taste
sensation, colicky pain and
abdominal tenderness, dragging
pain in the inguinal region, sore
throat and general depression
55. • Fever is usually between 39 and
40 degree C.
• Fever is typically but not
inevitably followed by a
remission of a few hours to 2
days. (Biphasic curve)
56. • The skin eruptions appear in 80%
of cases during the remission or
during the second febrile phase,
which lasts for 1- 2 days.
• The rash is accompanied by
similar but milder symptoms.
57. • The rash may be diffuse,
flushing, mottling or fleeting pin
– point eruptions on the face,
neck and chest during the first
half of the febrile period and a
conspicuous rash, that may be
maculopapular or
scarlantiniform on the third or
the fourth day.
58. • It starts on the chest and trunk and
may spread to the extremities rarely
to the face.
• It may be accompanied by itching
and hyperaesthesia.
59. • The rash lasts for 2 hours to
several days and may be
followed by desquamation.
• Fever lasts for about 5 days,
rarely more than a week after
which recovery is usually
complete although
convalescence may be
protracted.
60.
61. • Fever lasts for about 5 days,
rarely more than a week after
which recovery is usually
complete although
convalescence may be
protracted.
62.
63.
64.
65. DHF
• DHF is a severe form of dengue
fever.
• The course of dengue illness can
be divided into three febrile
phases
67. FEBRILE PHASE
• Following an incubation of 4 to 6
days, the illness commonly
begins abruptly with a high fever
accompanied by facial flushing
and headache.
68. • Anorexia, vomiting, epigastric
discomfort, tenderness at the
right costal margin and
generalized abdominal pain are
common.
69. • During the first phase of the
illness usually resembles classical
DF, but maculopapular rash
usually rubelliform type,is less
common.
71. • It may appear early or late in the
course of illness.
• Occasionally, the temperature
may be 40 degree to 41 degree C
and febrile convulsions may
occur particularly in infants.
72. • A positive tournicate test is the
most common haemorrhagic
phenomenon.
• The test is performed by inflating
a blood pressure cuff to a mid
point between systolic and
diastolic pressure for 5 min.
73. • The test is considered positive
when 10 or more petechiae per
2.5 x 2.5 cm -1 inch square) are
observed.
• In DHF, the test usually gives a
definite positive with 20
petechiae or more.
74. CRITICAL PHASE
• Around the time of defervescence,
when the temperature drops to
37.5-38 degree C or less, and
remains below this level, usually
on days 3-7 days of illness, an
increase in capillary permeability in
parallel with increasing
haematocrit levels may occur.
75. • This marks the beginning of the
critical phase.
• The period of clinically
significant plasma leakage
usually lasts 24-48 hours.
76. • Progressive leukopenia followed
by a rapid decrease in platelet
count usually precedes plasma
leakage.
77. • At this point patients without an
increase in capillary permeability
will improve, while those with
an increase in capillary
permeability may become worse
as a result of lose of plasma
volume.
78. • The degree of plasma loss varies.
• Pleural effusion, mostly on the
right side and ascitis may be
clinically detectable depending
on the degree of plasma leakage
and the volume of fluid therapy.
79. • Gall bladder oedema has been
found to precede plasma
leakage.
• Hence chest X ray and abdominal
ultrasound can be useful tools
for diagnosis.
80. • Shock occurs when a critical
volume of plasma is lost through
leakage.
81. • It is often precede by warning
signs of abdominal pain or
tenderness, persistent vomiting,
clinical fluid accumulation,
mucosal bleeding, lethargy and
restlessness, liver enlargement
more than 2 cm and oliguria.
84. • The body temperature may be
subnormal when shock occurs.
• With prolonged shock, the
consequent organ hypo
perfusion results in progressive
organ impairment, metabolic
acidosis and DIV.
85. • This in turn leads to severe
haemorrhage causing the
haematocrit to decrease in
severe shock.
86. • Instead of leucopenia usually
seen during this phase of
dengue, the total white cell
count may increase in patients
with severe bleeding.
87. • In addition to severe organ
impairment such as severe
hepatitis, encephalitis or
myocarditis and or severe
bleeding may also develop
without obvious plasma leakage
or shock.
88. • Those who improve after
defervescence are said to have
non severe dengue.
89. • Some patients progress to
critical phase of plasma leakage
without defervescence and in
the patients, changes in full
blood count should be used to
guide the onset of the critical
phase and plasma leakage.
90. • Those who deteriorate will
manifest warning signs.
• This is called dengue warning
signs.
91. • Cases with dengue warning signs
will probably recover with early
intravenous rehydration.
• Some cases will deteriorate to
severe dengue.
92. RECOVERY PHASE
• If the patient survives the 24-48
hour critical phase, a gradual re
absorption of extra vascular
compartment fluid takes place in
the following 48-72 hours.
93. • General wellbeing improves,
appetite returns, gastro
intestinal symptoms abate,
haemodynamic status stabilizes
and dieresis ensues.
94. • Some patients may have a rash
of “isles of white in the sea of
red”.
• Some may experience
generalized pruritis.
95. • Bradycardia and ECG changes are
common during this stage.
• The haematocrit stabilizes or
may be lower due to the dilution
effect of reabsorbed fluid.
96. • WBC count starts to rise soon
after defervescence., but the
recovery of platelet count is
typically later than that of WBC
count.
97. • Respiratory distress from
massive pleural effusion and
ascitis will occur any time if
excessive IV fluids have been
administered.
98. • Often due to fluid therapy
pulmonary oedema or
Congestive Heart Failure may be
reported during the treatment.
100. • 1. Plasma leakage that may lead
to shock,
• 2. Severe bleeding and / or,
• 3. Severe organ impairment.
101. • As dengue vascular permeability
progresses, hypovolaemia
worsens and results in shock.
• It usually takes place during
defervescence usually on day 4
or 5 (range 3-7 days) of illness.
103. • During the initial stage of shock, the
compensatory mechanism which
maintains a normal systolic pressure
also produces tachycardia and
peripheral vasoconstriction with
reduced skin perfusion, resulting in
cold extremities and delayed
capillary refill time.
104. • Uniquely, the diastolic pressure
rises towards the systolic
pressure and the pulse pressure
narrows as the peripheral
vascular resistance increases.
105. • Patients in dengue shock often
remain conscious and lucid.
• Inexperienced health personnel
may measure a normal systolic
pressure and misjudge the
critical state of the patient.
106. • Finally there is decompensation
and both the disappear abruptly.
• Prolonged hypotensive shock
and hypoxia may lead to multi
organ failure and an extremely
difficult clinical course.
107. • The patient is considered to have
shock if the pulse pressure is <
20 mm Hg in children or he/she
has signs of poor capillary
perfusion.
• In adults, the pulse pressure of <
20 mm Hg may indicate a more
severe shock.
108. • Hypotension is usually
associated with prolonged shock
which is often complicated by
major bleeding.
109. • Patients with severe dengue may
have coagulation abnormalities,
but these are not sufficient to
cause bleeding.
114. And at least one of the
following:
• Supportive serology on simple
serum sample : titre > 1280 with
haemagglutinin inhibition test,
• Comparable IgG titre with enzyme
linked immunosorbant assay ,
115. • Or testing positive in IgM
antibody test,
• Occurrence at the same location
and time as confirmed cases of
dengue fever.
116. CONFIRMED DIAGNOSIS
• A probable case with at least one
of the following:
1. Isolation of dengue virus for
serum, CSF, or autopsy samples.
117. 2. Fourfold or greater increase in
serum IgG (by
haemagglutination inhibition
test) in increase in IgM antibody
specific to dengue virus.
118. 3. Detection of dengue virus or
antigen in the tissue, serum or
CSF by immunohistochemistry,
immunofluorescence or enzyme-
linked immunosorbant assay.
119. 4. Detection of dengue virus
genomic sequence by reverse
transcription-polymerase chain
reaction.
122. IS CHARATERRIZED BY ALL OF
THE FOLLOWING :
• Acute onset of fever of two to seven
days duration.
123. • Haemorrhagic manifestations,
shown by any of the following:
Positive tourniquet test,
petechiae, ecchymoses or
purpura, or bleeding from
mucosa –GI tract/injection sites
or other locations.
124. • Haemorrhagic manifestations,
shown by any of the following:
Positive tourniquet test,
petechiae, ecchymoses or
purpura, or bleeding from
mucosa –GI tract/injection sites
or other locations.
127. • Objective evidence of plasma
leakage due to increased vascular
permeability shown by any of the
following: Rising
haematocrit/haemoconcentration >
20% from baseline or evidence of
plasma leakage such as pleural
effusion, ascitis or
hypoproteinaemia/albuminaemia.
128. DENGUE SHOCK SYNDROME
• Includes al the symptoms of DSS
including:
• Tachycardia, cool extremities,
delayed capillary refill, weak pulse,
lethargy or restlessness, which may
be a sign of reduced brain
perfusion.
129. • Pulse pressure < 20 mm Hg with
increased diastolic pressure, e.g.
100/80 mm Hg.
• Hypotension by age, defined as
systolic pressure < 80 mm Hg for
those aged < 5 years, 80 or 90
mm Hg for older children and
adults.
130.
131. LABORATORY DIAGNOSIS
• Rapid and accurate dengue
diagnosis is very important for
the following reasons.
1. Clinical management.
2. Epidemiological
surveillance.
137. VIRUS ISOLATION
• Isolation of dengue virus from
clinical specimens is possible
provided the specimen is taken
during the first six days of illness
and processed without delay.
138. • Specimen that are suitable for
virus isolation are- acute phase
serum, plasma or washed buffy
coat from the patient, autopsy
tissue from fatal case (liver,
spleen lymph nodes and
thymus), and mosquitoes
collected from affected area.
139. VIRUS NUCLEIC ACID
DETECTION
• Dengue viral genome, which
consists of RNA, can be detected
by reverse transcriptase
polymerase chain reaction (RT-
PCR) assay.
140. IMMUNOLOGICAL RESPONSE &
SEROLOGICAL TESTS
• THE FOLLOWING TESTS ARE AVAILABLE
• Haemagglutination-Inhibition test
(HI).
• Complement Fixation(CF).
143. VIRAL ANTIGEN DETECTION
• Elisa and dot blot tests are
directed against the
envelop/membrane antigens
and nonstructural protein 1
(NS1) can be detected in both
patients with primary and
secondary dengue up to 6 days
after the onset of illness.
144. RAPID DIAGNOSTIC TEST
(RDT)
• A number of commercial rapid
format serological test-kits for
anti-dengue IgM and IgG
antibodies are available in the
market.
145. • However the accuracy of
these tests is uncertain.
148. • The presence of thrombocytopenia
with concurrent haemoconcentration
differenciates grade I and grade II DHF
from DF.
149. MANAGEMENT OF
DENGUE FEVER
• For the patients who are able to
tolerate adequate volumes of
oral fluids and pass urine every 6
hours, and do not have any
warning signs adhere to the
following plan.
150. • Encourage intake of ORS, fruit
juice and other fluids containing
electrolytes and sugar to replace
losses from fever and vomiting.
151. • Adequate oral fluid intake may
be able to reduce the number of
hospitalizations.
152. • Administer Paracetamol for high
fever if the patient is
uncomfortable.
• The interval of Paracetamol
dosing should not be less than
six hours.
153. • Tepid sponge if the patient still
has high fever.
• Do not give Asprin (Acetylsalicilic
acid), ibuprofen or other non
steroidal anti inflammatory agents
(NSAIDs) as these drugs may
aggravate gastritis or bleeding.
155. • Instruct the care givers that the
patients should be brought to
hospital immediately if any of
the following occur:
1. No clinical improvement.
156. • 2. Deterioration around the time
of defervescence.
• 3. Severe abdominal pain.
• 4.Persistent vomiting or cold and
clammy extremities.
157. • 5. Lethargy or irritability,
restlessness, bleeding (black
stools or coffee-ground
vomiting).
• 6. Not passing urine for more
than 4-6 hours.
158. • Patients who are discharged
should be monitored daily by the
health care providers for
temperature pattern.
• Paracetamol is administered to
keep the temperature below 39
degree celcius.
159. • Copious amount of fluids should
be give to main fluid and
electrolyte imbalance.
• Patients should be monitored for
initial signs of shock.
160. • The critical period is during the
transition from the febrile to the
afebrile stage and usually occurs
after the third day of illness
161. • Serial haematocrit determinants
are essential guide for
treatment, since they reflect the
degree of plasma leakage and
need for IV therapy.
166. • A person with dengue
haemorrhagic fever with
thrombocytopenia and
haemoconcentration presents
with abdominal pain, black tarry
stools, epistaxis, bleeding from
gums and infection.
167. • All these patients should be
observed for signs of shock.
• The critical period for
development of shock is
transition from febrile to afebrile
phase of illness which usually
occurs in the third day of illness.
168. • A rise of haemoconcentration
indicates the need for IV fluid
therapy.
• Despite this treatment, if the
patient’s Bp falls with a decrease
in urine output, the management
for Grade III/IV DHF/DSS should
be instituted.
169. • Oral dehydration should be given
along with antipyrectics like
paracetamol, sponging.
171. • Common signs of complications
are observed during the afebrile
phase of DHF.
172. • Following hospitalization, the
haematocrit, platelet count and
vital signs should be examined to
assess the patient’s condition
and intravenous fluid therapy
should be started.
173. • The patient requires a regular
and sustained monitoring.
• If the patient has already
received about 1000 ml of IV
fluid, it should be changed to
colloidal solution preferably.
174. • Dextran 40/haemaccele or if
haematocrit is decreasing, fresh
whole blood transfusion
ml/kg/hour should be given.
175. • In case of persistent shock, after
initial fluid replacement and
resuscitation with plasma or
plasma expanders, the
haematocrit continues to
decline, internal bleeding should
be suspected.
176. • It is thus recommended to give
fresh whole blood in small
volumes of 10ml/kg/hour for all
patients in shock as a routine
precaution.
• Oxygen should be given to all
patients in shock.
178. • Loss of (overt blood) blood-10 %
or more of total blood volume-
preferably give whole blood or
components to be used.
• Refractory shock despite
adequate fluid administration
and declining haematocrit.
179. • Replacement volume should be
10ml/kg body weight at a time
and coagulogram should be
done.
• If fluid overload is present
packed cells are to be given.
181. • In general there is no need to
give prophylactic platelet even at
<,20,000cu.mm.
• Prophylactic platelet transfusion
may be given at level of <
10,000/cu.mm.
182. • Prolonged shock, with
coagulopathy and abnormal
coagulogram.
• In case of systemic massive
bleeding, platelet transfusion
may be needed in addition to
red cell transfusion.
184. • Absence of fever for at least
24 hours without use of anti-
pyretic drugs.
• Return of appetite.
• Visible clinical improvement.
185. • Good urine output.
• Minimum of 2-3 days after
recovery from shock.
• No respiratory distress from pleural
effusion or ascitis.
• Platelet count > 50,000/cu.mm.
186. DISEASE NOTIFICATION
• In dengue-endemic countries,
cases of suspected, probable and
confirmed dengue should be
notified as soon as possible so
that appropriate health
measures can be initiated.
188. MOSQUITO CONTROL
• The vectors of DF and DHF
(A.aegypti) breed in and around
houses and in principle
controlled by individual and
community action, using
antiadult and antilarval
measures.
196. VACCINES
• So far there is no satisfactory
vaccine and no immediate
prospect of preventing the
disease by immunization.
197. OTHER MEASURES
• Isolation under bed-nets during the
first few days; individual protection
against mosquitoes.
• Other personal prophylactic
measures.
• Environmental measures.