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Acute fever, body
malaise and rashes
in a 25 year old male
Group case presentation
6B
Laxamana, Michael
Laygo, Richard Joseph
Lee, Andria
Lee, Nica Kristine
Lerma, Joshua Dave
Libiran, Jonika Maris
Lim, Janine Abigail
Lim, Jerald Garvin
Lim, Joseph Michael
Module 4 Group 6 3B Med
6A
Joya, Jeb Reinard
Kalaw, Maria Natalia
Kho, Beatriz Barbara
Kimura, Akemi
King, Emmanuel
Koa, Daryl
Lacuna, Dan Paulo
Lalusis, John Kelvin
Lao, Nicole Mae
Laxamana, Jack Rene
Objectives• To present a case of a patient with acute fever
• To discuss differential diagnoses
• To discuss Dengue infection
– Epidemiology
– Pathophysiology
– Clinical manifestations
– Treatment & management
– Updates on diagnosis & treatment
GCP: Acute fever, body malaise & rashes in a 25 year old male
History6A Kalaw, Maria Natalia & Kimura, Akemi
6B Laxamana, Michael & Laygo, Richard Joseph
GCP: Acute fever, body malaise & rashes in a 25 year old male
General InformationName of Patient: J.R.P
Address: R. Papa, Manila
Age: 25 years old
Birthday: July 01, 1988
Sex: Male
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: College level (2nd yr. B.S. in Nursing)
Occupation: unemployed
Date Admitted: November 3, 2013 Bed No. 210 C
Date of Interview: November 8, 2013 (Hospital Day 6)
Informant: Patient
Informant Reliability: 90%
GCP: Acute fever, body malaise & rashes in a 25 year old male
A 25 year old male
Chief complaint: Fever
• chills, fever (39oC), body malaise• Self medicated Paracetamol (Biogesic) 500mg/tab 1tab PO
q4h• Amoxicillin 500mg/cap 1cap PO
Admission November 03, 2013
• fever 39.8oC, flushed face, red eyes, dry lips
2 days PTA
• fever (39.1 - 39.9oC), sore throat, • vomiting after meals, anorexia, • headache 5/10, myalgia on upper extremities 6/10, • knee arthralgia 4/10
13 hours PTA
2 hours PTA
GCP: Acute fever, body malaise & rashes in a 25 year old male
Past Medical History
• BIRTH AND DEVELOPMENTAL HISTORY: unrecalled
• CHILDHOOD ILLNESS/HOSPITALIZATIONS: none
• ADULT ILLNESS/HOSPITALIZATIONS: none
• SURGERIES: none
• INJURIES/ACCIDENTS: none
• TRANSFUSIONS/REACTIONS: none
• ALLERGIES: none
• IMMUNIZATION: unrecalled
A 25 year old male
GCP: Acute fever, body malaise & rashes in a 25 year old male
Personal and Social History• Smoking: 0.75 pack years (5 sticks per day since 2010)• Occasional social alcoholic beverage drinker (wine, beer, hard drinks)• No illicit drug use• Nutrition
– No eating difficulties, has good appetite– High salt diet – Usually eats a generous serving of vegetables & fruits
• Sleep Pattern– No difficulty in sleeping– Sleeps for about 9-10 hours a day, no naps in between
Family History(+) Asthma: Father, brother(-) Thyroid problems, DM(-) Hypertension & cardiovascular diseases(-) Cancer
GCP: Acute fever, body malaise & rashes in a 25 year old male
Personal and Social History• Marital status
Single
• Living arrangement/ Family structure
Has 2 older brothers and sister; youngest among siblings
Lives alone, rents an apartment unit beside older brother’s unit
• Support/secondary gains
Mother, older brother and sister-in-law are the primary caregivers.
Older brother supports patient financially
• Employment history/Job satisfaction
2010 Crew at McDonald’s UAE
2011 Promoted to Supervisor in McDonald’s UAE
2013 February – finished contract
• Sexual history
Had 1 sexual partner (Filipina OFW, UAE, 2012)
• Significant life events, deaths, hardships
2007 death of father due to car accident
denied having financial hardship thereafter
GCP: Acute fever, body malaise & rashes in a 25 year old male
REVIEW OF SYSTEMSGeneral Conscious, coherent, not in respiratory distress
Skin (-) pigmentation, (-) pruritus, (-) jaundice, (-) pallor
HEENT (+) blurring of vision, (-) ear discharge, (-) ear pain, (-) epistaxis, (-) gum bleeding, (-) hoarseness, (-) ulcers
Cardiovascular (-) palpitations, (-) cyanosis, (-) chest pain, (-) PND, (-) orthopnea, (-) easy fatigability
Respiratory (-) cough, (-) colds, (-) exertional dyspnea
Gastrointestinal (-) constipation, (-) diarrhea, (-) melena
Genitourinary (-) urgency, (-) hematuria, (-) oliguria, (-) dysuria, (-) nocturia,
Musculoskeletal (-) swelling, (-) Inflammation
Neurologic (-) seizures, (-) tremors, (-) sleep disturbance, (-) alterations of mood
Hematologic (-) easy bruisability, (-) anemia
Endocrine/Metabolic (-) polyphagia, (-) polyuria, (-) polydipsia, (-) heat/cold intolerance
Psychiatric (-) depression, (-) hallucinations
GCP: Acute fever, body malaise & rashes in a 25 year old male
Physical Examination6A Kalaw, Maria Natalia & Kimura, Akemi
6B Laxamana, Michael & Laygo, Richard Joseph
GCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•Conscious, coherent, awake
•GCS 15
•Ambulatory
•not in respiratory nor cardiac distress
•oriented to time, place and person
• cooperative, neutral mood, broad affect
• no agitation
• judgment and insight intact
• intact memory for recent and remote events
•Conscious, coherent, awake
•GCS 15
•Ambulatory
•not in respiratory nor cardiac distress
•oriented to time, place and person
• cooperative, neutral mood, broad affect
• no agitation
• judgment and insight intact
• intact memory for recent and remote events
General survey
GCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•BP = 110/80 mmHg (Sitting)
• PR = 107 bpm, regular
• RR = 20 breaths per min, regular
• Temp 38.7 °C (Axillary)
•Height = 165 cm
•Weight = Kg
•BMI = 18.5 (Normal)
•BP = 100/80 mmHg (Sitting)
• PR = 65 bpm, regular
• RR =19 breaths per min, regular
• Temp 36.0 °C (Axillary)
•Height = 165 cm
•Weight = 53 Kg
•BMI = 18.5 (Normal)
Vital Signs & Anthropometrics
GCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•(-) petechiae
• Warm, moist
• no facial flushing
• no palmar erythema
• pink nail beds, no clubbing
•(+) petechiae on both lower extremities
• Warm, moist
• no facial flushing
• no palmar erythema
• pink nail beds, no clubbing
Skin
GCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)• Head : round, symmetrical & no deformities, no lesions or masses
Eyes : no ptosis & exophthalmospink palpebral conjunctivaanicteric sclera
pupils 2-3mm equally reactive to light, (+) ROR
•Ears : no ear deformities and tenderness, gross hearing intact, intact tympanic membranes, nonhyperemicexternal auditory canals•Nose: no alar flaring, no nasal discharge
• Mouth: pinkish lips, moist buccal mucosa, no cyanosis
•no oral ulcers
•Throat: non hyperemic posterior pharyngeal wall
•tonsils not enlarged
•Tongue not deviated
•uvula in midline
•Supple neck, no limitation in motion
•no palpable cervical masses and lymph nodes
• Head : round, symmetrical & no deformities, no lesions or masseshair is black, ample in volume & with smooth texture
Eyes : no ptosis & exophthalmospink palpebral conjunctivaanicteric sclera
pupils 2-3mm equally reactive to light, (+) ROR
•Ears : no ear deformities and tenderness, gross hearing intact, intact tympanic membranes, nonhyperemic external auditory canals•Nose: no alar flaring, no nasal discharge
•septum at midline
•non-congested nasal turbinates
•moist nasal mucosa
• Mouth: pinkish lips, moist buccal mucosa, no cyanosis
•no oral ulcers
•Throat: non hyperemic posterior pharyngeal wall
•tonsils not enlarged
•Tongue not deviated
•uvula in midline
•Supple neck, no limitation in motion
•no palpable cervical masses and lymph nodes
HEENTGCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•Symmetrical chest expansion
•Not in respiratory distress
•no tenderness upon palpation of chest
•normal tactile and vocal fremiti on all lung fields
•no adventitious breath sounds on all lung fields
•symmetrically resonant on all fields
•Symmetrical chest expansion
•no chest deformities
•trachea midline
•regular pattern of breathing
•no use of accessory muscles, SCM not prominent
•no tenderness upon palpation of chest
•normal tactile and vocal fremiti on all lung fields
•no adventitious breath sounds on all lung fields
•symmetrically resonant on all fields
Thorax/LungsGCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•JVP 3 cm at 30 degrees
•carotid artery pulse with rapid upstroke and gradual downstroke
•adynamic precordium
•no murmurs, no thrills, heaves or lifts
•S1 > S2 at apex, S2 > S1 at base, no S3 or S4
•(+)2 on radial, dorsalis pedis, posterior tibialis, brachial and popliteal pulses
•JVP 3 cm at 30 degrees
•carotid artery pulse with rapid upstroke and gradual downstroke,
•adynamic precordium
•no murmurs, no thrills, heaves or lifts
• apex beat 11.5 cm from sternum at 6th ICS, on the Left, 1 fingerbreadth soft in characteristic
• S1 > S2 at apex, S2 > S1 at base, no S3 or S4
•(+)2 on radial, dorsalis pedis, posterior tibialis, brachial and popliteal pulses
Chest/HeartGCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•abdomen is flat and symmetrical
•umbilicus in midline
•normoactive bowel sounds
•tympanitic at all quadrants
•No tenderness on light & deep palpation
•abdomen is flat and symmetrical
•no visible pulsations and peristalsis
•umbilicus in midline and inverted
•normoactive bowel sounds, no borborygmi
•tympanitic at all quadrants
•No tenderness on light & deep palpation
•Liver span = 9 cm Right MCL
•Traube’s space is not obliterated
Abdomen/GastrointestinalGCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)
•(-) CVA tenderness •(-) CVA tenderness•non palpable kidneys
GenitourinaryGCP: Acute fever, body malaise & rashes in a 25 year old male
On Admission (November 3, 2013) Upon PE (November 8, 2013)Cranial Nerves
CN I No anosmia
•CN 2 : pupils 2-3 mm ERTL, (+) direct and consensual light reflex on both eyes, corneal reflex intact, (+) accommodation, (-) visual field defect, (-) ptosis
•CN 3 4 6: EOMs full & equal
• No nystagmus, no drooping of eyelids
•CN 5: no sensory deficit on the left of face
•CN 7: Can clench teeth, can smile, can frown
•CN8 : Gross hearing intact
•CN 9 10: (+) gag reflex, Uvula midline on phonation
•CN 11: Can shrug both shoulders
•CN 12: No deviation of the tongue on protrusion
Cerebrum: •GCS 15 (E4 V5 M6)•Conscious, coherent, awake•Oriented to time, place & person•Follows commands
Cerebellum• Able to do finger-to-nose test & alternate
pronation-supination test
Cranial Nerves
CN I No anosmia
•CN 2 : pupils 2-3 mm ERTL, (+) direct and consensual light reflex on both eyes, corneal reflex intact, (+) accommodation, (-) visual field defect, (-) ptosis
•CN 3 4 6: EOMs full & equal
• No nystagmus, no drooping of eyelids
•CN 5: no sensory deficit on the left of face
•CN 7: Can clench teeth, can smile, can frown
•CN8 : Gross hearing intact
•CN 9 10: (+) gag reflex, Uvula midline on phonation
•CN 11: Can shrug both shoulders
•CN 12: No deviation of the tongue on protrusion
Neurologic examGCP: Acute fever, body malaise & rashes in a 25 year old male
Subjective Objective
• Fever, chills • body malaise• sore throat, vomiting after
meals, anorexia• headache 5/10 • myalgia on upper extremities
6/10, • knee arthralgia 4/10
• Vital signsBP: 100/80PR: 65 bpmRR: 19 cpmTemp: 36 oC
Salient Features25 y.o. Male
GCP: Acute fever, body malaise & rashes in a 25 year old male
Initial ImpressionAcute Viral Infection
GCP: Acute fever, body malaise & rashes in a 25 year old male
Differential Diagnosis6A King, Emmanuel & Lao, Nicole Mae
6B Lee, Andria & Lee, Nica Kristine
GCP: Acute fever, body malaise & rashes in a 25 year old male
PatientChikungunya Virus
InfectionInfluenza
Rocky Mountain Spotted Fever
Fever 39oC
Chills
body malaise
Sore throat
Vomiting after
meals
anorexia
headache
myalgia,
arthralgia
Rashes on both
lower extremities
Fever(38oC-39oC)Chills
MyalgiasArthralgiasHeadache
PhotophobiaCoughCoryza
Pharyngitis AnorexiaNausea
VomitingFatigueMalaise
SplenomegalyDark urine/clay-colored stools before the onset
of jaundiceExposure to endemic areas/ contaminated
food/water
Acute Fever not responding to antibiotic
therapyHeadache
Physical Findings:Conjunctival SuffusionPharyngeal erythema
w/o exudateMuscle tenderness
Dullness on lung percussion
Rales on lung auscultation
Rash (maculopapular,erythematous, petechial
or ecchymotic)Exposure history
FeverAbdominal pain
HeadachePhotophobia
Vomitting Vertigo
Sore throatMeningeal signs
LethargySomnolence
Disoriented/Intellectual deficit
TremorsLoss of abdominal
reflexesCranial nerve palsies
HemiparesisDifficulty in swallowing
Tick borne
Source: Harrison’s Principles of Internal Medicine 18th edition
GCP: Acute fever, body malaise & rashes in a 25 year old male
Source: Harrison’s Principles of Internal Medicine 18th edition
Patient Hepatitis A Infection Leptospirosis
Fever 39oC
Chills
body malaise
Sore throat
Vomiting after
meals
anorexia
headache
myalgia,
arthralgia
Rashes on both
lower
extremities
Fever(38oC-39oC)Chills
MyalgiasArthralgiasHeadache
PhotophobiaCoughCoryza
Pharyngitis AnorexiaNausea
VomitingFatigueMalaise
SplenomegalyDark urine/clay-
colored stools before the onset of jaundiceExposure to endemic areas/ contaminated
food/water
Acute Fever not responding to antibiotic
therapyHeadache
Physical Findings:Conjunctival SuffusionPharyngeal erythema
w/o exudateMuscle tenderness
Dullness on lung percussion
Rales on lung auscultation
Rash (maculopapular,erythematous, petechial
or ecchymotic)Exposure history
Dengue Fever
FeverHeadacheWeaknessAnorexia
General body pain (arthralgias, myalgias)
Abdominal pain Vomiting
Maculopapular rashSore throat
Mild hemorrhagic manifestations (eg, petechiae, bleeding
gums, epistaxis, hematuria)
LymphadenopathyMosquito vector
GCP: Acute fever, body malaise & rashes in a 25 year old male
Course in the ward6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin
6B Lim, Janine Abigail & Lim, Jerald Garvin
GCP: Acute fever, body malaise & rashes in a 25 year old male
0.4
0.3
0.2
0.1
0
200
150
100
50
0
Day 1 (11/03) Day 2 (11/04) Day 3 (11/05) Day 4 (11/06)
Sx Fever, sore throat, Abd. Pain
Fever Fever Fever
Hgb 132g/L 129g/L 130g/L 141g/L 140g/L
Hct 0.38 0.38 0.37 0.40 0.40
WBC 3.10x109/L(N:0.62, L:0.36, Eo:0.02)
2.50x109/L(N:0.69, L:0.31)
1.90x109/L(N:0.46, L:0.51, Mo:0.03)
3.40x109/L(N:0.19, L:0.78, Mo:0.02,
Eo:0.01)
5.00x109/L(N:0.17, L:0.79,
Mo:0.02, Eo:0.02)
PLT 185x109/L 180x109/L 90x109/L 33x109/L 51x109/L
Na 135mmol/L 141mmol/L
K 3.72mmol/L 3.98mmol/L
Other Crea: 0.93mg/dLALT: 39.42U/L
Dengue NS1: (+)
AST: 51.37 U/LALT: 37.26 U/L
Fecalysis: No significant findings
Paracetamol 500mg Tablet prn
Rx Paracetamol 500mg Tablet IV Fluid (LRS)
Esomeprazole 40mg/tab
Paracetamol 500mg TabletPRN
Paracetamol 500mg Tablet
PRN
Paracetamol 500mg Tablet PRN
1 2 3 4 4
0.4
0.3
0.2
0.1
0
200
150
100
50
0
Day 5 (11/07) Day 6 (11/08)
Sx Rashes Rashes
Hgb 137g/L 140g/L 130g/L
Hct 0.40 0.39 0.37
WBC 4.80x109/L(N:0.14, L:0.83, Eo:0.03)
4.10/x109/L(N:0.19, L: 0.75,Mo:0.02,
Eo:0.04)
4.30x109/L(N:0.16, L:0.77,
Mo:0.02,Eo:0.05)
PLT 39x109/L 73x109/L 80x109/L
Rx Paracetamol 500mg Tablet PRNCetirizine 10mg Tablet OD
None
1 23
4 4 56
6
Final Clinical DiagnosisDengue Infection
(with warning signs of abdominal pain, vomiting, lethargy, increased Hct & rapid increase in platelet count)
GCP: Acute fever, body malaise & rashes in a 25 year old male
Pathophysiology6A Kho, Beatriz Barbara & Laxamana, Jack Rene
6B Lerma, Joshua Dave & Libiran, Jonika Maris
GCP: Acute fever, body malaise & rashes in a 25 year old male
Types of PatientGroup A
• are able to tolerate adequate volumes of oral fluids
• pass urine at least once every six hours
• do not have any of the warning signs, particularly when fever subsides
Group C
• severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress
• severe hemorrhages
• severe organ impairment
Group B
• with warning signs
OR
• Without warning signs but with:
• co-existing medical conditions
• certain social circumstances
DOH Revised Dengue Clinical Management Guidelines, 2011
GCP: Acute fever, body malaise & rashes in a 25 year old male
WHO. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control, 2009
GCP: Acute fever, body malaise & rashes in a 25 year old male
FEBRILE PHASE CRITICAL PHASE RECOVERY PHASE
FeverHeadache
Body malaiseMyalgia
ArthralgiaRetro-orbital pain
AnorexiaNausea
VomitingDiarrhea
Flushed skinRash
Defervescence
Abdominal pain or tenderness
Persistent vomitingClinical signs of fluid
accumulationMucosal bleeding
Lethargy; restlessnessLiver enlargement
Resorption of extravasated fluid
Hemodynamic status stabilizes
DOH Revised Dengue Clinical Management Guidelines, 2011
GCP: Acute fever, body malaise & rashes in a 25 year old male
Philippines: 7th
WHO Global Strategy For Dengue Prevention and Control .2012
“The incidence of dengue has increased 30-fold over the last 50 years. Up to 50-100 million infections are now estimated to occur annually in over 100
endemic countries, putting almost half of the world’s population at risk.”
GCP: Acute fever, body malaise & rashes in a 25 year old male
Dengue in the Philippines• 1953- first epidemic of severe dengue
• Dengue cases: 110,611(2012) vs 102,192(2013)
Source: Department of Health (DOH)
GCP: Acute fever, body malaise & rashes in a 25 year old male
DENGUE
Human
VirusMosquito
Aedes aegypti
-breed indoors and are capable of biting anyone throughout the day
-less susceptible to climatic variations →increases the mosquitoes’ longevity.
Source: WHO. Programmes and Projects: Dengue Control. http://www.who.int/denguecontrol/en/
PathophysiologyGCP: Acute fever, body malaise & rashes in a 25 year old male
Ashley, L. et.al. Barriers to preclinical investigations of anti-dengue immunity and dengue pathogenesis. Nature Reviews 11, 420–426 (2013)
GCP: Acute fever, body malaise & rashes in a 25 year old male
Viral replication in white blood cells: Cytokine production= IL-1, IL-6, TNF, IFN → Inflammatory response
Fever: ↑PGE2 in hypothalamus→↑cAMP→ altered thermoregulatory set point
Myalgia: Perivascular mononuclear infiltrates + Lipid accumulation Microbiology
Nausea and vomiting: bloodborne emetic stimuli (H1 and 5-HT)
Increased endothelial permeability
• Rashes/petechiae (pinpoint hemorrhages)
• Induced vasodilatation = dopamine and 5-HT release → headache
Goals of Therapy,Treatment & Management
6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin
6B Lim, Janine Abigail & Lim, Jerald Garvin
GCP: Acute fever, body malaise & rashes in a 25 year old male
Treatment and Management• Revised Dengue Clinical
Case Management Guidelines
• DOH
• 2011
GCP: Acute fever, body malaise & rashes in a 25 year old male
Monitoring– Temperature pattern– Volume of fluid intake and losses– Urine output – volume and frequency– Warning signs– Hematocrit, WBC and Platelets counts
Source: DOH A.O. No. 2012-0006, Revised Dengue Clinical Management Guidelines 2011
Discharge Criteria
• ALL of the following must be present
No fever for 48 hours
Improvement in clinical status
General well-being
Appetite
Hemodynamic status
Urine output
No respiratory distress
Increasing trend of platelet count
Stable hematocrit without IV fluids
GCP: Acute fever, body malaise & rashes in a 25 year old male
Home Care for Dengue• Adequate bed rest
• Adequate fluid intake (>5 glasses for average-sized adult or accordingly in children)
– Milk, fruit juice (caution with diabetes patient) and isotonic electrolyte
solution (ORS) and barley/rice water
– Plain water alone may cause electrolyte imbalance
• Take paracetamol (not more than 4 grams per day for adults and accordingly in
children)
• Tepid sponging
• Look for mosquito breeding places in and around the home and eliminate them
• AVOID: NSAIDs, Acetylsalycylic acid (aspirin), Mefenamic acid, Steroids (If
already taking, consult physician)
• Antibiotics are not necessary
Source: DOH A.O. No. 2012-0006, Revised Dengue Clinical Management Guidelines 2011
GCP: Acute fever, body malaise & rashes in a 25 year old male
D.E.N.G.U.E.
D aily monitor the patient’s status
E ncourage intake of oral fluids like oresol (oral rehydration solution), water and juices
N ote any warning signs of dengue like persistent vomiting and bleeding
G ive paracetamol to the patient, NOT aspirin as it induces bleeding
U se mosquito nets/repellants
E arly consultation with doctors for any warning signs
Source: DOH A.O. No. 2012-0006, Revised Dengue Clinical Management Guidelines 2011
GCP: Acute fever, body malaise & rashes in a 25 year old male
GCP: Acute fever, body malaise & rashes in a 25 year old male
Euphorbia hirta Linn. (Euphorbiaceae) “Tawa-tawa”
• To determine the validity of the anti-thrombocytopenic effect of E. hirta in animal models with subnormal platelet counts due to ethanol.
• The platelet count (Micros Counter), bleeding time (Duke’s method), and clotting time was determined
• Histopathological analysis of the liver and spleen
Thrombocytopenia induction by ethanol
Euphorbia hirtadecoction (100 mg/kg
by oral gavage) Administration
Blood Collection on Day 7 and 14
Platelet Count
Bleeding Time
Clotting Time
Histopathological Exam
• Platelet count increased by 38.9 ± 9.6%
• Bleeding time improved by 59.38 ± 6.44%
• Clotting time improved by 46.6 ± 11.3%
• Histopathological Exam– Less dilated liver sinusoids in ethanol + E. hirta
decoction group
– No notable difference in spleen• This was most likely due to the short duration (1 week) of
induction of thrombocytopenia may have caused liver damage but was insufficient to cause any significant changes to the spleen.
“Although there were small amount of phenolic compound in tawa-tawa, this was sufficient to exert effect promoting quality and quantity of
platelets,” Mr. Raynes said.
Because of the study’s significant findings, it won the first prize in the PCHRD – Gruppo Medica Award held during the 6thPhilippine National Health Research System (PNHRS) Week held at Sofitel Manila last 10 August
2012. PCHRD – Gruppo Medica Award is given to undergraduate students engaged in herbal medicine research that have potential for practical or commercial applications.
Updates on Diagnosis6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin
6B Lim, Janine Abigail & Lim, Jerald Garvin
GCP: Acute fever, body malaise & rashes in a 25 year old male
GCP: Acute fever, body malaise & rashes in a 25 year old male
GCP: Acute fever, body malaise & rashes in a 25 year old male
GCP: Acute fever, body malaise & rashes in a 25 year old male
Clinical Question
• What test can I utilize to confirm a diagnosis of Dengue in my patient?
• Key Words: Dengue, Rapid Diagnosis
AppraisalAre the results of the study valid?
- Patients were all selected during a Dengue outbreak in 2011- Selected patients presented with a history of fever within the
past 7 days with at least one of the following : rash, severe headache, retro-orbital pain, myalgia, joint pains, bleeding
- Patients were randomly selected, with a maximum of 10 hospitalized patients per hospital per week
- All patients were sampled twice (early and late), with early samples tested by PCR, viral isolation, HIA and MAC-ELISA, while late samples were tested with only HIA and MAC-ELISA
What were the results?
- In a comparison between hospital laboratories and a national reference laboratory, the sensitivity, specificity, PPV and NPV of the NS1/IgM/IgG combination tests were capable of early detection of Dengue infection
- optimal performance of the tests require adequate training and quality assurance as there was a significant difference in the values between hospital laboratories and the national reference laboratory.
The results also showed that the sensitivity of the combined diagnostic kit did not vary
significantly between the serotypes and was unaffected by the patient’s immune status or by the interval of time between fever onset
and sample collection
Are the results applicable for your patient?
- Given our patient’s presentation and history, performing a diagnostic test capable of confirming the diagnosis of Dengue early will contribute to an optimal clinical management of the patient, and avoid unnecessary use of antibiotics and other drugs/ancillaries, limiting patient expenses in the process.
Updates on Prevention6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin
6B Lim, Janine Abigail & Lim, Jerald Garvin
GCP: Acute fever, body malaise & rashes in a 25 year old male
GCP: Acute fever, body malaise & rashes in a 25 year old male
The graphic will identify the type of pest the product is expected to repel & the amount of time the repellent will be effective.
Source: United States Environmental Protection Agency http://www.epa.gov
GCP: Acute fever, body malaise & rashes in a 25 year old male
Technological Initiatives
GCP: Acute fever, body malaise & rashes in a 25 year old male
Technological Initiatives• Dengue Vaccine
– Final stage of clinical development
– Sanofi Pasteur dengue vaccine
• Only vaccine entered Phase III clinical study
• Mexico, Colombia, Honduras, Puerto Rico, Peru, Vietnam, Singapore, Australia, Thailand and the Philippines
• Initial data showed very satisfactory results in terms of safety profile and balance immune system response to the four dengue serotypes (serotype 1,2,3 and 4) among children, adolescents and adults tested
Source: http://www.pchrd.dost.gov.ph
GCP: Acute fever, body malaise & rashes in a 25 year old male
Source: http://www.pchrd.dost.gov.ph
Technological Initiatives
• Ovicidal LarvicidalTrap
– Ordinary tin can painted black
– Strip of lawanitboard
– Solution
GCP: Acute fever, body malaise & rashes in a 25 year old male
Source: www.cdc.gov; www.dost.gov.ph
Technological Initiatives
Dengue Vector Surveillance websites– Mosquito population nationwide– Dengue incidence, other mosquito-related facts
GCP: Acute fever, body malaise & rashes in a 25 year old male
Technological Initiatives
Biologic Agents– Larvivorous fishes
• Gumbusia affinis, a fresh water fish species, commonly known as “gambusia”, “kataba”, “bubundat” or “mosquito fish,”
• Poecilia reticulate, commonly known as “guppy fish,” can also consume about 80 to 100 mosquito larvae per day
– Predatory copepods like water bugs• Diplonychus indicus
– Sterile male mosquito
Source: http://www.dost.gov.ph
Thank you!
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