Cord around neck
Sunday, 1 April 2012
rubella
http://en.wikipedia.org/wiki/Rubella
http://en.wikipedia.org/wiki/Congenital_rubella_syndrome
http://en.wikipedia.org/wiki/Congenital_rubella_syndrome
Congenital rubella
syndrome features:
The classic triad for
congenital rubella syndrome is:
§
Sensorineural
deafness (58% of patients)
§
Eye
abnormalities—especially retinopathy,cataract and microphthalmia (43%
of patients)
Other manifestations of
CRS may include:
§
Spleen, liver or bone marrow problems
(some of which may disappear shortly after birth)
§
Small head size (microcephaly)
§
Eye defects
§
Low birth weight
§
Thrombocytopenic purpura (presents as
a characteristicblueberry muffin rash)
Children who have been
exposed to rubella in the womb should also be watched closely as they age for
any indication of the following:
§
Diabetes
§
Glaucoma
Rubella
Symtoms ,incubation period
After an incubation period
of 14–21 days, German measles causes
symptoms that are similar to the flu.
The primary symptom of
rubella virus infection is the appearance of a rash (exanthem) on the face
which spreads to the trunk and limbs
and usually fades after three days
(that is why it is often referred to as three-day measles).The facial rash
usually clears as it spreads to other parts of the body.
Other symptoms include low grade fever, swollen glands
(sub occipital & posterior cervical lymphadenopathy), joint pains, headache and conjunctivitis.[6] The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 oC (100.4 oF).
The rash of German measles is
typically pink or light red. The rash causes itching and often lasts for about three days. The rash disappears
after a few days with no staining or peeling of the skin. When the rash clears
up, the skin might shed in very small flakes where the rash covered it.
Forchheimer's sign occurs in
20% of cases, and is characterized by small, red papuleson the area of the soft palate.
Rubella virus?
The disease is caused by
Rubella virus, a togavirus that is enveloped and has a single-stranded RNA
genome.[9] The
virus is transmitted by the respiratory route and replicates in the nasopharynx and lymph
nodes.
Diagnosis
Rubella virus specific IgM antibodies are present in people recently infected by
Rubella virus but these antibodies can persist for over a year and a positive
test result needs to be interpreted with caution.[12] The
presence of these antibodies along with, or a short time after, the
characteristic rash confirms the diagnosis.
Vaccination?
Rubella infections are prevented
by active immunisation programs using live, disabled virus vaccines.
Two live attenuated virus
vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of
adult disease.
However their use in prepubertile
females did not produce a significant fall in the overall incidence rate of CRS
in the UK. Reductions were only achieved by immunisation of all children.
Vaccination in children?
The vaccine is now usually given
as part of the MMR vaccine.
The WHO recommends
the first dose is given at 12
to 18 months of age with a second dose at 36 months.
Pregnant women are usually tested
for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the
baby is born because the vaccine contains live virus.[
thalasemia
Case thalassemia
Pt hv u/l beta
thalassemia diagnosed in 2000 with hypersplenism
Currently pw lethargic, reduced effort tolerance, mild sob,
dizziness, bilateral leg swelling, periorbitsl sweling
On examination ptn jaundice, pale , thalassemic facies,
frontal bossing, distended abdomen, with hepatosplenomegaly( massive
splenomegaly), leuconychia, elevated jvp, PSM at mitral area, (TR with loud P2)
Impression:
1.hbe beta thalasemia
2. heart failure
Ix=
pt/aptt, inr, fbc, rft, urine feme, ecg
mx-
·
-transfuse 1 pint pack cell
·
-for echo
·
-t.hematinic
Pethidine
Pethidine
Pethidine (INN) or Meperidine
Hydrochloride (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol;
pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in
Indonesia); Petidin Dolargan (in Poland);[2] Dolestine; Dolosal; Dolsin; Mefedina) is a fast-actingopioid analgesic drug.
Is it synthetic or original?
Pethidine was the first synthetic opioid.
Indication?
Pethidine is indicated for
the treatment of moderate to severe pain,
Mode of action?
and is delivered as a hydrochloride salt in tablets,
as a syrup, or by intramuscular, subcutaneous or intravenous
injection.
Mode of action?
Pethidine exerts its
analgesic effects by acting as an agonist
at the kappa
opioid receptor, primarily.[ In addition to its strong opioidergic and anticholinergic effects, it has local anesthetic activity
related to its interactions with sodium
ion channels.
side effects in :Pregnancy
- Pethidine is sometimes given to pregnant women during labor to relieve pain. However, this can cause side effects in the baby, such as trouble breathing and drowsiness. Pethidine can also diminish a baby's sucking reflex, making nursing difficult.
Side Effects
- Constipation, nausea, vomiting, headache, drowsiness, confusion, rash or skin irritation, dry mouth, dizziness, fatigue or weakness, small pupils, sweating, increased feelings of well-being, changes in urination, hallucinations, blushing of the face, low blood pressure and feeling cold are all side effects of pethidine.
blood transfusion
1. how much elevation of hb if 1 pint pack cell is transfused to the patienbt?
answer: 1g
2. how much elevation of platelet level if 1 pint platelet is transfused to the patient?
answer: 10 000
3.what is the content of fresh frozen plasma (FFP) and cryoprecipitate?
4. what is DIVC regime?
http://myhow.wordpress.com/2010/07/15/antepartum-haemorrhage/
answer: 1g
2. how much elevation of platelet level if 1 pint platelet is transfused to the patient?
answer: 10 000
3.what is the content of fresh frozen plasma (FFP) and cryoprecipitate?
4. what is DIVC regime?
http://myhow.wordpress.com/2010/07/15/antepartum-haemorrhage/
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