Italian pharmacy online: cialis senza ricetta medica in farmacia.
Microsoft word - 07 - fever.docx
Fever– A Clinical Approach - Dr. Sabir
• An oral temperature exceeding 37.2°C in the early morning and 37.7°C in the late afternoon or evening (Rectal
temperatures are higher by approximately 0.6°C )
• The mean diurnal temperature oscillation is approximately 0.5°C, with women generally having slightly higher
normal temperatures than men. Temperature is lowest in the early morning and highest in the late afternoon or early evening. The diurnal rhythm is usually preserved with a fever
What is fever?
• FEVER is a Diagnostic Clue • It is an essential host defense mechanism • Associated with or without localizing signs • It can be due to Infection, inflammation or neoplasm
• Hyperthermia—not mediated by cytokines—occurs when body metabolic heat production or environmental
heat load exceeds normal heat loss capacity or when there is impaired heat loss; heat stroke is an example. Body temperature may rise to levels (> 41.1 °C) capable of producing irreversible protein denaturation and resultant brain damage; no diurnal variation is observed.
• Antipyretics are effective in treating fever but are unlikely to affect hyperthermia.
Neuroleptic malignant syndrome
is a rare and potentially lethal idiosyncratic reaction to major tranquilizers
(haloperidol, fluphenazine). Treatment
: dantrolene ± bromocriptine or levodopa
occurs within hours of ingestion of agents that increase levels of serotonin in the CNS, including
serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, pethidine, dextromethorphan,
bromocriptine, tramadol, and lithium. Treatment
: central serotonin receptor antagonist—cyproheptadine or
chlorpromazine ± a benzodiazepine.
• Intermittent type – temp return to normal once during most days • Remittent type – temp do not return to normal each day • Sustained/Continuous – temp do not vary more than 1 degree F /day • Relapsing - recurrent over days to weeks
TYPES OF PUO:
3. Cause not diagnosed after 3 OP visits or 3 days of
PUO – causes
• INFECTIONS – 40% • MALIGNANCY –30% • CONNECTIVE TISSUE D- 20 % • UNDIAGNOSED – 10 %
: amoebic liver abscess, brucellosis, TB, Typhoid, IE….etc • Malignancy
: solid tumors (pancreas, lung, sarcoma, colon…etc) • Systemic dis
: SLE, Reiter’s, granulomatous hepatitis…etc • Miscellaneous
: drug fever, factitious fever, hyperthyroidism, Behcet’s dis, FMF…etc
• Any drug may be responsible • Examples: nitrofurantoin, phenytoin, hydralazine, methyldopa, quinidine, quinine, procainamide • Very rarely caused by: digoxin, aminoglycosides • Peripheral eosinophilia is a clue but present only in 25%
Fever with hepatosplenomegaly
• Malaria • Typhoid • Lymphoma • Leukemia • Disseminated tb • Infective endocarditis • Brucellosis • Kala azar
• Tb • Temporal arteritis • Carcinoma • Lymphomas • Abscess • Myeloproliferative disorder
Fever & low platelets
• BONE SCAN- OSTEOMYELITIS, METASTASIS
• VIRAL CULTURE + IN EBV, CMV INFECTIONS
Safety data sheet according to 1907/2006/EC, Article 31 / ISO 11014 Printing date 13.08.2013 Version number 5 Revision: 13.08.2013 1 Identification of the substance/mixture and of the company/undertaking · Product identifier · Trade name: Hilti B 36 / 3.0 Li-Ion Hilti B 36 / 3.3 Li-Ion Hilti B 36 / 3.9 Li-Ion Hilti B 36 / 6.0 Li-Ion · Relevant identified uses of th
Audited grouP resuLts for the year ended 30 september 2013 • Turnover increased 18% to R5,45 billion • EBITDA increased 11% to R1,1 billion • HEPS decreased 17% to 350,5 cents • Acquisition of Cosme brands in India concluded at a cost of R782 million • Shareholder approval pending for scheme of arrangement proposing a cash and shares transaction with CFR• Departure