OSCE

As part of my prefinal exam on 01Dec,I presented a case of 25 yr old female with NS1 positive dengue( link is shared below-case blog)

https://91jasmisri.blogspot.com/2023/11/25-year-old-female-with-dengue-ns-1.html

Learning points:-

-I have learnt that Regular Bp monitoring importance in dengue

- I have also learnt the importance of investigations like hess test, hemotrict value ,platelet count monitoring

-Pathogenesis of platelets detoriation in dengue

OSCE questions:-

Treatment options other than iv fluids in dengue

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411372/

▪︎Immunomodulation

▪︎Corticosteroids :-recent retrospective study showed some benefit with methylprednisolone in patients with severe dengue.There is a clear need for adequately powered, randomized, double-blind, placebo-controlled clinical trials in both children and adults to evaluate fully the possible benefit or lack of benefit of corticosteroids in dengue infection.

▪︎Intravenous immunoglobulins :-One important conclusion was that intravenous immunoglobulins were safe, with no significant side effects being encountered during the trial. There is currently insufficient evidence to make any recommendation regarding the use of intravenous immunoglobulins in dengue shock,6 and further studies are required.

▪︎Carbazochrome sodium sulfonate (AC-17), a hemostatic drug with a capillary-stabilizing action.Its effect in severe dengue was investigated in a small randomized clinical trial conducted in 95 Thai children.No evidence of benefit in either outcome measure was seen using AC-17

▪︎A randomized controlled trial compared the use of nasal continuous positive airway pressure (NCPAP) versus oxygen by mask in 37 Vietnamese children with dengue shock state and acute respiratory failure. It was shown that NCPAP effectively decreased hypoxemia and reduced the number of children requiring intubation and ventilation. Thus, NCPAP appears to be an effective treatment in acute respiratory failure associated with dengue shock state