WHO - HIV treatment guidelines - 2016

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RNTCP latest treatment guidelines - 2016

Treatment guidelines can be downloaded from the links given below.
Chapter 1
Chapter 2

Zika Virus - Recent updates 2016

Zika virus is a RNA virus belonging to filovirus family and transmitted by Aedes mosquitoes.
Its maternal-fetal transmission and anecdotal reports of sexual transmission have been reported.
Aedes mosquitoes usually bite during the daytime and breed in standing water so prevention is similar to dengue fever.
It’s a predominant mild or asymptomatic dengue like disease without any hemorrhagic tendencies. Symptoms occur in just 20-25% of patients with low case fatality rates. . It causes acute onset low grade fever with multiple small joint pain, muscle ache, eye pain, prostration and maculopapular rash and usually present 2 to 12 days after mosquito bite.
Recent reports suggests its association with fetal microcephaly and intra cranial calcification which requires antenatal serial Ultrasonography and biochemical evaluation in suspected cases
Treatment is bed rest and supportive care.

Similar to dengue aspirin should be avoided and hematocrit and pulse pressure needs to be monitored.
Diagnostic Algorithm for Zika virus detection
Reference :- PAHO & WHO guidelines

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Dengue fever - What you must know

It’s a viral infection caused by flavivirus and transmitted by aedes mosquito.

Aedes mosquito usually bites during day time and breeds in stagnant water. Since dengue virus has four antigens so there is risk of getting dengue again for maximum 4 times.

Usually it’s a self limiting illness but it may progress to Dengue hemorrhagic fever and Dengue shock syndrome.

Thrombocytopenia is usually seen on 3-4 day of fever and decreasing trend till 6th day and again increases from 7th day.

If there is pain abdomen, breathlessness, bleeding, hypotension or low blood pressure, hospitalization is recommended.

Rule of 20 for Doctors - Rise in hematocrit (pcv) more than 20% and fall by 20% after fluid replenishment, 20 petechiae in tourniquet test, pulse pressure less than 20mm of hg

Treatment remains supportive... paracetamol for fever and plenty of fluids. For inpatients if platelet is less than 10000 platelet transfusion is done. Avoid drugs which may cause thrombocytopenia...

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Diabetes management during Ramadan

Ramadan, a holy month of Islam varies between 29 and 30 days. Muslims who fast abstain from eating drinking smoking and use of oral medications.
Patients of diabetes mellitus who fast are at greater risk of complications which are hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), Diabetic ketoacidosis, dehydration and thrombosis.
Medical recommendation most often for the patients is to not undertake fasting. But if they insist on fasting they must make such decision in consultation with their doctors understanding risks associated with it.
Management is individual centric.
General considerations
1. There should be frequent monitoring of blood glucose level.
2. Nutrition should be adequate enough to maintain a constant body mass. Avoid taking heavy sunset meals rich in carbohydrate and fats. Take plenty of fluids during non fasting hours and food containing complex carbohydrates at the predawn meal is advised.
3. Normal level of exercise. Avoid excessive exercise as it may cause hypoglycemia.
4. Breaking the fast. If blood sugar is less than 60mg/dl anytime or less than 70mg/dl within few hours of fast, or if blood sugar is in excess of 300mg/dl.

Management of Type 2 Diabetes mellitus

1. Patients controlled with lifestyle modification alone may distribute calories over 2 to 3 smaller meals to avoid hyperglycemia.
2. Patients on oral drugs- insulin sensitizers like metformin are preferred.
Those treated with metformin can safely fast. Dose needs to be modified - 2/3 of total dose should be given with sunset meal and 1/3 before predawn meal.
Pioglitazones are not independently associated with hypoglycemia but they can’t be substituted for any other OHA as it takes 2-4 weeks to exert its effects.
Sulfonylureas like glimepride, glyburide, glipizide are not recommended in view of hypoglycemia risk.
Glinides may be taken twice daily as it is short acting.
DPP 4 inhibitors (gliptins) are best tolerated drugs and can be taken. Alpha glucosidase inhibitors like acarbose miglitol and voglibose can be taken.

Patients treated with insulins :

One long or intermediate acting insulin injection along with short acting insulin before meal can be used. Use of 50:50 premixed insulin in evening and 30:70 insulin at early morning was also found useful.
Insulin pump is better option.

References :- ADA guidelines

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Snake bite - what should not be done

What should not be done?

1. Do not apply a tourniquet. (Don’t tie arm or leg with rope or clothes as it’s unnecessary and makes the condition worse for the patient.)
2. Do not wash the bite site with soap or any other solution to remove the venom. 
3. Do not make cuts or incisions on or near the bitten area.
4. Do not use electrical shock.
5. Do not freeze or apply extreme cold to the area of bite. 
6. Do not apply any kind of potentially harmful herbal or folk remedy.
7. Do not attempt to suck out venom with your mouth.
8. Do not give the victim drink, alcohol.
9. Do not attempt to capture, handle or kill the snake and 
9. Patients should not be taken to quacks.

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IQ Classifications

IQ score ranges (from DSM-IV): 

  • Mild mental retardation: IQ 50–55 to 70; children require mild support; formally called "Educable Mentally Retarded".

  • Moderate retardation: IQ 35–40 to 50–55; children require moderate supervision and assistance; formally called "Trainable Mentally Retarded".

  • Severe mental retardation: IQ 20–25 to 35–40; can be taught basic life skills and simple tasks with supervision.

  • Profound mental retardation: IQ below 20–25; usually caused by a neurological condition; require constant care.
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