General Tropical Med (from revision session) Flashcards
Entamoeba Histolytica
Diagnosis?
Treatment?
If extrahepatic- Serology
If intrahepatic liver abscess - then aspirate (anchovy like non-odouress substance - positive for trophozoites)
Metrondiazole + amoebicide
Giardia treatment
metronidazole or tinidazole
Ascaris lumbricoides
disease it causes?
transmission?
why does it cause symptoms?
= Roundworm
faeco-oral
tends to create high volume of worms which can cause bowel obstruction
Hookworm
transmission?
Through skin penetration
Trichurius
disease?
Symptoms?
Whipworm
Particularly in children - UC like symptoms (incl bloody diarrhoea), anaemia, rectal prolapse, tenesmus, nocturnal soiling
Strongyloides
Transmission
Important relevance of this condition?
rash related to this?
Through skin
It can cause superinfection in immunosuppressed as its life cycle can occur solely in humans - autoinfection
Larva Currens
Cutaneous Larva Migrans related to?
dog/cat hookworm
Taenia Solium
disease?
important significance of this type?
Pork tapeworm
humans can be the intermediate hosts in this infection meaning that the cystercerci can cause cystercercosis (in brain, muscles, eye etc)
Echinococcus causes…
Hydatid disease
D. Latum = which disease?
associated with?
Fish tapeworm
associated with megaloblastic anaemia
Schistosomiasis transmission?
cercariae penetrate through skin in fresh water (after having developed from miricidae into cercaria in snails). Then they lose their tails and migrate through lymphatics to the hepatic portal system over 2-3 weeks maturing. Then male and female join (for life) and go to bowel or bladder.
Schistosomiasis initial reaction?
Immediately - urticarial rash where penetration is
at 21 days post infection = Katayama Syndrome (fever, rash, cough, abdo pain)
Schistosomiasis treatment?
Praziquantel (2 doses)
MDA with praziquantel also
Fasciola hepatic disease?
Transmission?
symptoms?
treatment?
Liver fluke
Eating watercress
fever, hepatomeghaly and liver dysfunction
Tx: triclabendazole
Paragonimus westermanni
disease?
transmission?
treatment?
Lung fluke
from eating Crabs/crustaceans
Praziquantel or triclabendazole
Lymphatic filariasis Parasite names?
Typical effect in the lungs?
Treatment?
Brugia Malayi, Wuchereria Bancrofti
- can cause pulmonary eosinophilia which is asthma-like (cough, wheeze, high eosinophils)
Tx: Inside Africa - Albendazole + Ivermectin
- Outside Africa - DEC + albendazole + ivermectin (as long as sure no Loa Loa)
Diseases that cause eosinophilia?
Schistosomiasis
Hookworm
Ascaris lumbricoides
Strongyloides
Lymphatic filiariasis
Lung fluke (Paragonimus Westermani)
Onchocerciasis
transmitted by?
where does it affect?
Black fly bites (simulium)
skin - nodules, ITCHING!! sowda (darkened skin), lizard skin and leopard skin and eyes - leading to blindness (optic nerve atrophy and keratitis)
onchocerciasis diagnosis?
Tx?
bloodless skin snip
tx: ivermectin (if confident it isn’t Loa Loa (i.e. if out of africa). Give Doxycycline (as this won’t affect LoaLoa and is safe)
Loa Loa
transmission?
Tx?
important consideration?
= Eye Worm
transmitted through chrysops fly bite
tx: DEC if low filariae, if high then give slow albendazole in hospital or over 21 days
NB: if have Oncho as well and you gave DEC then can cause Marzotti reaction - must rule this out first.
Guinea Worm features?
Tx?
fiery worm!
causes ulceration as adult worm comes out of skin
Treatment - gradually using a pencil to pull out the worm
HAT life cycle
what form of parasite enters humans?
metacyclic tryposmastigotes and turn into bloodstream trypomastigotes - these either become long, slender forms which are able to evade immune system with the VSGs (variable antigenic presentation) and multiply, and the short, stumpy forms which can be taken up blood meal of tsetse fly
HAT tx?
Rhodiense?
Gambiense?
For gambiense 1st and 2nd stage = fexinidazole
Rhodiense 1st stage = Suramin
2nd stage = Melarsoprol
Chaga’s disease
stage of entering human?
lifecyle in human
trypomastigotes enter human –> transform into intracellular amastigotes –> transform into trypomastigtes which burst out of the cell and into blood stream
Chagas treatment?
Important to remember regarding who needs treatment?
Benznidazole for 60 days (doesn’t change trajectory if already has chronic cardiomyopathy etc)
If in indeterminate phase (as proved by positive serology but asymptomatic) you need to treat if Children, pregnant, of childbearing age or immunosuppressed
Leprosy stages
- TL tuberculous Leprosy - good immune response - granulomas, paucibacillary
- BT borderline tuberculoid
- BB Borderline
- BL borderline lepromatous
- LL lepromatous Leprosy - poor immune response, high bacillary load
Cutaneous Leishmaniasis
Vector?
Diagnosis?
Vector - sandflies
- impression smear
- skin biopsy using microscopy, PCR, serology (DAT) or culture
Visceral Leishmaniasis
Onset?
Diagnosis?
Mainly Leishmania Donovani
Sub-acute - over months
Spleen/bone marrow/LN aspirate for microscopy, PCR, or serology/urinary antigen
Visceral Leishmaniasis tx:?
tx: miltefosine and liposomal amphotericin B
Vipers snakebite effects?
Swelling at bite site with necrosis sometimes. Then can lead to coagulopathy and haemorrhage.
Elapids snake bite effects?
Local effects minimal (unless cobras)
Neurotoxicity predominates
Useful test in snakebite assessment?
20 min whole blood clotting test (if not clotted after 20 minutes you know you’ve got serious problems!)
Sea snakebite effects?
No local effects. Leads to myotoxicity and paresis
Buruli ulcer
Bacteria?
Where might you see it?
Treatment:
Mycobacterium ulcerans
West Africa
Rifampicin + macrolide/streptomycin
Leprosy
1. paucibacillary
2. multibacillary
treatment?
- Dapsone, rifampicin and clofazimine for 12 months
- Dapsone and Rifampicin for 6 months
Reasons why someone might present with a fever VERY unwell in low resource setting?
later presentation
Anti-microbial resistance
poor fluid balance
poor diagnostics
Severe falciparum malaria treatment?
IV Artesunate (or IV quinine if don’t have artesunate)
Then oral stepdown to ACT after at least 24 hrs of IV
Role of Primaquine in Malaria treatment?
- Can give single dose of primaquine in low transmission areas (to clear gametocytes to prevent onward transmission)
- Or you give 14 days course of Primaquine for eradication of hypnozoites in liver for vivax or ovale
tx for non falciparum malaria?
if not chloroquine reistance then give that.
Otherwise give ACT
Malaria elimination efforts (list of five)
- vector control (ITN, IRS etc)
- Diagnosis and tx of cases
- IPT (in pregnancy, infants and seasonal)
- ?MDA in future
- Vaccine delivery
Typhoid fever Diagnosis?
via blood culture
Widal Test (serology)
Typhoid complications
shock
syndrome of confusion
encephalopathy
cholecystitis
bowel perforation
GI bleeding
Melioidosis bacteria?
Burkholderia pseudomallei
Risk factor for melioidosis?
diabetic
CKS
CLD
alcoholism
long term steroids
Melioidosis features?
Tx?
acute sepsis + abscess formation in skin and viscera + suppurative parotitis + multifocal pneumonia
Tx: Ceftazidime (resistant to ceftriaxone)
Leptospirosis complications?
Treatment?
ARDS (pulmonary haemorrhage), AKI and Transaminitis
Tx: Doxycycline or amox
If severe: penicillin IV
Bubonic plague symptoms?
Can become pneuomonic - significance?
Fever, headache chills and swollen LN (called buboes)
Once pneumonic then it can spread more easily - aerosol-borne/inhalation
Dengue Virus
transmitted by?
Aedes Aegyptii
Important monitoring and indications of worsening Dengue?
Abdo pain, fluid oedema, mucosal bleeding and hepatomegaly
Falling platelet count, rising haematocrit
Japanese Encephalitis
transmitted by?
Culex Mosquito
How to respond to possible VHF outbreak?
- waste management
- PPE supply
- washing of linen
- cleaning rota
- safe burials
- isolated triage area and barrier nursing
- donning and doffing area (observed)
- Inform country’s public health authorities - ask for support
- contact tracing
…
Risk factors for TB (i.e. increased chance of not clearing initial infection)
HIV, Vit D deficiency, Malnutrition and diabetes
Diagnosis of Pulmonary TB
Sputum smear - microscopy
TB culture
Gene Xpert (ultra) = gold standard
CXR and clinical symptoms
HIV test
TB tx priniciples
Intensive phase - 2RHZE
Continuation phase - 4RH
What to discuss before TB tx?
adherence
discuss SE
Advise about contraception
check visual acuity
Check LFTs
get baseline Weight (monitor this for sign of effective tx)
Investigations for extra-pulmonary TB
Urinary LAM for HIV+ve patients and GU EPTB
Culture of gastric aspirate/LN/pericardial aspirate/pleural aspirate/bone biopsy (dependant on where!)
- MDR drug resistance meaning?
- RR/MDR meaning?
- Pre-XDR meaning?
- XDR meaning?
- resistant to at least rifampicin and izoniazid
- rifampicin resistant
- Fluroquinolone, rifampicin and isoniazid resistance
- fluroquinolone, bedaquiline and or linezolid resistant as well as MDR
reasons for TB drug resistance?
poor adherence
No DOTS
Drug supply issues
malabsorption
didn’t complete course
HIV initial tx?
Two NRTIs and PI/INSTI/NNRTI
e.g. Tenofovir and Lamivudine and Doltegravir (or Efavirenz)
HIV counselling 5 key points to address
no cure
lifelong treatment
U=U
partner notification
adherence
What signifies HIV treatment failure?
Viral Load >1000
If 1st time have adherence talk and re-test in 3 months. If still raised then, then change medications
gram negative?
gram positive?
red/pink on slide
purple on slide
Pyogenic meningitis -
where is it common?
belt of sub-saharan africa
India ink stain used for which pathogen?
Cryptococcal - creates a halo. Usually associated with HIV.
Cryptococcal meningitis tx:
Induction - amphotericin B single dose +flucytosine + fluconazole for first two weeks
Consolidation - fluconazole 8 weeks.
Maintenance: fluconazole for a year
Steroid of no benefit
Tetanus
Symptom presentation
Key feature: the shorter the incubation period the more severe the disease
Trismus (can’t open mouth) –> muscle spasms –> autonomic dysfunction
In neonates - silent seizures/spasms
Tetanus
Bacteria name?
Treatment?
Clostridium Tetani - Gram +ve bacillus, anaerobe
Tx: metronidazole and penicillin, give antitoxin, spasm control, wound debridement
Rabies incubation period
2-3 months
Cholera on microscopy?
curved bacilli
stained pink as gram negative
Cholera treatment?
Fluid replacement/ORS most important
doxy/azith/cipro
Vaccine available in outbreaks
Shigella dysteriae sx:
bloody diarrhoea
Cutaneous anthrax
bacteria type?
symptoms?
Gram positive bacillus
rapidly developing black eschar, not painful
(NB; can also affect GI (worst outcome) and resp)
If skin lesion in Solomon islands?
Think Yaws (endemic treponemas)
Hepatitis B
Diagnosis?
treatment?
Diagnosis: LFTs, (HbeAg +ve), then HBV DNA PCR. then do fibroscan
Tx: NB: you don’t treat everyone - you treat those with high HBV DNA and rasied ALT, (irregardless of HbeAg) - give Tenofovir
Hepatitis D treatment
Interferon (for 12-24 months)
Way to prevent Maternal Haemorrhage
- optimise Hb antenatally
- USS to know placenta location
- Skilled birth attendant at delivery
- education around warning signs to mother
- have waiting homes available
Three stages of delay
- in realising need to seek care
- in getting to place of healthcare (transport)
- in receiving care
3 ways to reduce risk of maternal sepsis in c-section
- handwashing and clean water access
- prophylactic abx if c-section
- using chlorhexidine to clean vagina after birth
Treatment for Rickettsial diseases?
Doxycycline
Leprosy diagnosis investigations?
Skin slit smear for Microscopy
Skin biopsy for culture
Clinical diagnosis with a thickened peripheral nerve observed
Human African trypanosomiasis
Diagnosis?
Card agglutination test (only for Gambiense though)
Thin and thick films for microscopy
Aspiration of LN
Describe the bacteria causing Tuberculosis
Gram positive intracellular acid fast bacilli with a waxy cell wall
In a new diagnosis of HIV in which cases do you not start treatment straight away?
Cryptococcal meningitis - 4-6 weeks afterwards
TB meningitis - 6-8 weeks afterwards
Diagnostics for TB meningitis?
CSF - low glucose, raised protein and high lymphocytes, turbid, raised OP
CSF culture
CSF smear microscopy with ZN stain - AFB
MRI - showing tuberculomas
HIV test
Look elsewhere for TB - clinical signs, CXR, Gene Xpert sputum,
When to give steroids in TB treatment?
Pericardial TB
TB meningitis (unless has HIV)
Pleural TB
Mass deworming for Soil transmitted helminths
- If prevalence over 50% give Albendazole 2/year to children
- If prevalence over 20% give Albendazole 1/year to children
Distinction between the morphology of stronglyloides and hookworms
Hookworms - larger buccal cavity, smaller primordium (genitals) and tapering tail
Strongyloides - smaller buccal cavity, bulging primordium and a bifid tail
For Soil transmitted helminths which infections is NOT treated with Albendazole first line?
Strongyloides - first line = Ivermectin
Brucellosis - important consideration when testing for this bacteria?
Treatment?
It is a highly contagious disease and a biohazard for lab staff so to culture it can use the MALDI TOF technique.
PCR also and serology
Tx: Doxycycline and streptomycin for 6-12weeks
When screening a patient newly diagnosed with HIV what should you test?
TB + PCP - CXR
CrAG
Look at eyes for toxo/CMV
Blood borne viruses - HBV, HCV
Syphilis/STI screen
Immunisations
CD4 count (understand stage of disease)
Pregnancy test
Difference in transmission between NTS and Typhoidal salmonella
Tx for each?
NTS - food-borne incl. meat, eggs and processed foods
Typhoid - faeco-oral
Tx:
- Ceftriaxone AND azithromycin for typhoid
- Ciprofloxacin or ceftriaxone for NTS
Symptoms of PCP?
Typical CD4 count?
Diagnosis?
Treatment?
- Sx: dry cough, excertional dyspnoea, subacute onset, low oxygen
- CD4<200
- Dx: deep sputum sample for miscroscopy + CXR (widespread perihilar ground glass opacification,sparing the peripheries)
- Tx: Co-trimoxazole and start ART!
Preventative treatment for TB?
IPT (isoniazid preventative therapy)
- for children <5 with a household member who is smear positive
- HIV +ve
- newborn with a negative TST at birth to a TB +ve mother
BCG Vaccine for children
What is different about the pathophysiology of TB in patients with HIV?
- Poorer granuloma formation
- Poorer antigen presentation on surface of macrophages so CD8 killer cells don’t know to apoptose the macrophages
- Poorer cytokine response so weaker immune repsonse - hence why you get less reaction on TST/IGRA, fewer CXR changes and less smear positivity
Good tests for TB in PLHIV?
Urine LAM
Gene Xpert Ultra
Treatment for Aspergillosis in HIV patients?
Voriconazole for 6-12 weeks
Start ART
Aspergillosis on CXR
Affects upper lobes
Air crescent sign seen
Anthrax treatment?
60 days of ciprofloxacin (or doxycycline)
If lung/neuro/GI then add on Rifampicin, chloramphenicol or clindamycin
Why is one more vulnerable to malaria during pregnancy?
- More attractive to mosquitoes - breathing off more CO2, warmer skin temp, and immunosuppressed.
- More likely to come out from under bed nets at night due to more frequent urination
- Can sequester in the placenta so largely evade the mother’s immune system.
Consequences of malaria in pregnancy?
IUGR
Pre-term birth
*with Vivax, you have more synchronous sporozoite release so fever peaks tend to be higher which can be likely to lead to spontaneous abortion/delivery
The premise of Malaria control focus in high and low trasmission areas?
In high transmission areas - focus should be on prevention
In low transmission areas - focus should be on identify and treating patients
Malaria tx: what else do you need to consider alongside ACT?
- Monitor glucose (hypos common in children)
- blood transfusions (don’t give iron if anaemic)
- Supportive care - IV fluids for renal support
- anti-pyretics
Name the five ACTs for malaria
- artemether-lumefantrine (the drug you should give in 1st trimester if non-severe)
- artesunate-mefloquine
- dihydroartemisinic-piperaquine
- artesunate-amodiaquine
- artesunate-sulphadoxine-pyrimethamine
How to distinguish between a child who has SAM and also severe dehydration?
Tx for the severe dehydration?
Both will have reduced skin turgor, sunken eyes and lethargy.
So look for CRT>3secs and eagerness to drink to indicate severe dehydration.
Tx: Do NOT give IV fluids - give ReSoMal 5mg/kg every 30 mins for 2 hours, then alternate with F-45 formula.
Bejel
what is it?
diagnosis?
non-venereal treponeme
Sx:
Primary - single painless, white ulcer (self resolves.
Secondary - multiple lesions across mouth, tongue, lips
Tertiary - can spread to CNS and CVS
Diagnosis: serology
Tx: BenPen
What is hydatid caused by?
where does it affect?
Diagnosis?
Treatment?
Echinococcus (small tapeworm parasite)
70% affects lung - single cyst with pressure symptoms
20% lungs (salty cough, SOB)
10% other (can go to brain)
Diagnosis: USS Liver and aspiration, biopsy
ELISA (IgM)
Tx: Surgery, Albendazole and PAIR (injection of sclerosing agent into cyst)
What is the Vaccine for yellow fever called?
17D live attenuated vaccine
symptoms of Japanese Encephalitis?
Diagnosis?
seizures, mask-like facies, parkinsonism, coma, spasms, flaccid paralysis
Dx: ELISA IgM, MRI (shows thalamic lesions), raised liver enzymes (AST and ALT)
Helpful thing to remember r.e. diagnostics for all Arboviruses?
In first few days you can generally do PCR when there is high viraemia. (the window for this is very short in JE so rarely done)
After this do an IgM ELISA for antibody testing.
What features make up FURIOUS rabies?
Affects the brain. Median time to death = 9 days.
Causes spasms, aerophobia, hydrophobia, autonomic dysfunction with excess salivation and labile BP etc., fever and encephalopathy
What features make up DUMB Rabies?
Affects the spinal cord. Median time to death = 20 days.
Fever, fasciculations, ascending paralysis, up until respiratory and bulbar paralysis
What diagnostic test is common to all the viral haemorrhagic fevers?
PCR
Name of Ebola vaccine?
ERVEBO (V920) - for anyone who has been in contact with someone with Ebola
5 features that make CCHF slightly different to Lassa and Ebola?
- shorter incubation period (2-4 days)f
- haemorrhage as 1st presentation (not a sign a DIC)
- no GI symptoms
- has a vector bite (ixodae tick)
- can do ELISA antibody test also
Complications of shigella?
Focal infection (meningitis, osteomyelitis, arthritis)
dehydration
hypoglycaemia
hyponatraemia
febrile seizures
toxic megacolon
bowel obstruction (rarely perforation)
Differentials for acute non-bloody diarrhoea
Cholera
Giardia
Rotavirus
Lassa
Ebola
Malaria in children
Cryptosporidium
Isosporiasis/cyclosporiasis/cystoisosporiasis
Non typhoidal salmonella
Differentials for blood acute diarrhoea?
Shigella
Typhoid (salmonella)
Campylobacter
Enteroinvasive E coli
Enterohaemorrhagic E Coli
(chronic = Entamoeba histolytica, hookworms, whipworms, strongyloides, schistosomiasis)
Differentials for Cough and fever
Histoplasmosis
TB
CMV
Talaromycosis
blastomycosis
Q fever
Influenza
Covid
Bacterial pneumonias
PCP
Melioidosis
Katayama syndrome (schistosomiasis)
Differentials for Pharyngitis and Fever
HIV seroconversion
Diphtheria
Strep A infection (can lead to Rheumatic fever)
Differentials for rash and fever?
Melioidosis (ulcers)
Strongyloides (larva currens every 30 days)
Dengue (maculopapular rash)
Chikungunya (maculopapular rash)
Endemic Murine typhus (centripetal maculopapular rash)
Anthrax (Eschar)
Scrub Typhus (Eschar)
Tick Typhus (Eschar)
Epidemic Typhus (maculopapular rash sparing the hands and feet)
Measles (pustules and papules and Koplik spots)
Monkeypox (multiple papules and condyloma)
HIV seroconversion (morbilliform rash on palms and soles of feet)
Secondary syphilis (rash on palms and soles of feet)
Switching HIV treatments - when and to what?
Tenofovir + Lamivudine + Efavirenz —> (switch after 6 months straight away if NNRTI) to TVR+3TC+DTG
TVR+3TC+DTG —> (after 6 months and then another 3 months to see if it improves) to Zidovudine (AZT) + Lamivudine (3TD) + Lopinavir LPR/R
What is risk pooling?
The idea of sharing risk amongst a whole population/many members of a group. Only works if it is mandatory. Risk pooling increases efficiency and equity
What is a QALY?
Quality adjusted Life Year - it is a measurement of health. It is a way of measuring how many years of perfect health an intervention provides.
You use survey data that is country and culture specific to be able to calculate these.
WHO recommends using this for vaccination interventions.
What is a DALY?
It is the number of healthy years lost due to a disability + the number of years lost due to early mortality due to that disease. You use a disability weight to calculate a DALY.
Different types of risk pooling?
Unitary risk pool (all in one pool)
Fragmented risk pool (risk groups are devolved and put together according to need or demographics and there is a set amount of money per person allocated)
Integrated risk pool (people are in different groups but there can be transfer of money between different fragments)
Different Health financing methods?
- Taxed based system (equitableand progressive.governments can be inefficient with funds)
- Donor system (less autonomy/consistency and less reliable, redistributes wealth though)
- Insurance based - social (allows for flux in economy to have bearing on resources available, but is otherwise progressive and enables poorer people to have healthcare they couldn’t afford otherwise) or private (allows choice or provider, but there is always gaps in the provision)
- Out-of-pocket payments (regressive - affects poorest people the most, allow individual monetary autonomy)
Different types of Epi Curves
- Point Source (typically a food poisoinong outbreak, no human to human trasmission)
- Propagated source (likely to have human to human trasmission)
- Continuous source (often follows on from propagated source)
- Intermittent source
What does a missed vaccine opportunity look like?
- concerns about vaccine wastage
- HCW anti-vax attitude
- not actively screening upon every interaction
- vaccine clinics not being at a time when everyone could attend
- fear of side effects
Storage of vaccines depend on?
humidity
light
temperature
security
What is the difference between Cost-Benefit Analysis and Cost-Effectiveness Analysis?
CBS is looking at the inputs and outputs of an intervention purely in monetary terms, whereas a CEA or CUA looks at the input (which is money) and output which often is something like a QALY to measure the benefit/effectiveness of an intervention
What affects women’s health?
Education
Affordability
Accessibility
Acceptability
Empowerment/Autonomy
Availability
What are the different elements of Quality of Care?
Timeliness
Equity
Effectiveness
Efficiency
Safety
Patient centredness
What are social determinants of health?
They are the factors such as where you are born, grow, live, work, play and age that have an impact on your health that are outside of an individual’s control.
What is the difference between Equity and Equality?
Equity is the absence of unfair, avoidable or remediable differences between people.
Equality is the idea of fairness being based upon giving everyone the same thing.
What do you need to think of within WASH?
- Water supply
- excreta management
- solid and water waste management
- sanitation education
- dead bodies
- vector control
Outbreak Management Key points
- Prepare for field work
- establish there is an outbreak
- verify diagnosis with laboratory findings
- construct a working case definition (incl. person, place, time and features of disease)
- Create a Line list (descriptive epidemiology)
- Develop hypotheses
- do further studies if required
- Implement swift diagnosis/treatment/control interventions
- Initiate and reinforce surveillance
- communicate your findings
Core humanitarian principles
- Independence
- Impartiality
- Neutrality
- Humanitarian imperative at the core - alleviating human struggle
Humanitarian considerations?
Rapid Initial Assessment (factoring numbers, demographics etc,)
Shelter and site planning
WASH facilities
Nutrition and food
Vaccine coverage
Curative treatment
Communicable disease control
Targets for End-TB?
- Patient centred care (Supportive care - moving away from DOTS)
- Research
- Reduce cost to the individual to nil
- Active case finding
Reasons to downgrade GRADE Assessment
downgrade for:
- RISK OF BIAS (too small sample size)
- PUBLICATION BIAS
- INDIRECTNESS (does it answer the question)
- IMPRECISION (how broad the confidence intervals are - i.e. if it were at the extremes of either CI would this change your clinical practice?)
- INCONSISTENT (heterogeneity)
Complications of measles?
- subacute sclerosing panencephalitis
- pneumonia
- otitis media
- diarrhoea
How to assess Stunting?
Do height for age Z scoring (<2 SD = stunting)
(<3 SD = severe stunting)
A Public Health campaign to manage diabetes?
- Nurse led campaign for monitoring and screening for diabetes
- Nurse-led outreach for glucose testing and monitoring
- Integrated care - Opportunistic testing upon all patient interactions
- patient education programmes for inpatients
- education programmes run in local townships as free events to come to
- collecting epidemiological data to evidence the extent of this NCD to lobby the government for money to subsidise treatment and above interventions
- task shifting - by upskilling Community Health Workers that could do finger prick blood testing and signpost if any DM complications identified in the townships
- Upstream approach - Increase taxes on sugar
What is in PrEP?
Tenofovir
What is in PEP?
4 weeks of Tenofovir, Emtricitabine and Dolutegravir
start within 72 hours of exposure
What do you give children who are breastfeeding from a HIV +ve mother not on ART?
What do you give newborns born to mother on ART for HIV?
Nevirapine and Zidovudine for 12 weeks
If not breastfed give both for 6 weeks
Nevirapine OR Zidovudine for 6 weeks if not breastfed or 12 weeks if breastfed
How do you test a newborn for HIV from a HIV +ve mother?
Do a NAAT test (includes HIV RNA) - if negative then re-test at 4-6 weeks and then 9 months. If sitll negative then re-test using ELISA for antibody testing at 18 months or 3 months after stopping breastfeeding
1st line treatment choice for children with HIV?
Abacavir + Lamivudine + dolutegravir (or Lopinavir/r)
1st line treatment choice for neonates with HIV?
Zidovudine (or Abacavir) + Lamivudine + Raltegravir
List some important Gram positive bacteria (stains purple/blue)
Listeria (gram positive bacillus)
C. Difficile (gram positive bacillus)
Staph Aureus (gram positive cocci)
Streptococcus (gram positive diplococci)
List some important gram negative bacteria (stains red/pink)
Neisseria Meningitides (gram negative diplococci)
Salmonella Typhi (gram negative bacillus)
E Coli (gram negative bacillus)
Haemophilus Influenzae (gram negative diplococci)
