Dr Mehtab Khattak MBBS MD

15/11/2025

From Dengue protocol to complication control.
From ATOM:

Dengue usually settles by Day 5–7.

If the patient is still unwell after Day 5, it is NOT dengue anymore ,it is a complication.
Dengue has a fixed timeline:

• Day 1–3: Fever + viremia
• Day 4–6: Critical leak window
• Day 7 onwards: Recovery

If the patient is still sick after Day 5, you must assume a secondary problem.
Never keep blaming dengue after Day 5.

What makes a dengue patient sick after Day 5?

1. Fluid overload / pulmonary edema (MOST COMMON)
This is the #1 reason patients are breathless or deteriorating after Day 5.
Because the leak has stopped, but the excess fluids remain inside → lungs fills .
Treatment: Stop fluids, diuretics, oxygen, CPAP/ventilation.

2. Late bleeding.
Once leak closes, patients may develop occult or overt bleeding.
• Falling hematocrt Tachycardia ,Abdominal pain,Drop in Hb.
Treatment: Blood transfusion.

3. Secondary bacterial infection.

After the immune storm settles, immunity drops → bacterial infection with restart of fever etc.
Treatment: Start antibiotics based on clinical suspicion.

4. Myocarditis / cardiomyopathy.

Dengue can cause myocardial depression.

Signs:
• Hypotension despite no leak.
• Gallop, basal crepts.
• Elevated troponin.
• Echocardiographic global hypokinesia.
Treatment: Inotropes, cautious fluids, ICU.

5. Liver failure / severe hepatitis!

Severe hepatitis in dengue peaks around Day 5–7.
Treatment: N-acetylcysteine, tight ICU support.

6. Prolonged marrow suppression (platelets + WBCs).
Rare, but can occur ,counts don’t rise.
This is when eltrombopag MAY be used, but usually only after acute dengue is over ,recent data show early use may help too as antiviral.

7. Hemophagocytic lymphohistiocytosis (HLH) ,rare but deadly .
remember RARE MANIFESTATION OF COMMON DISEASES VERY COMMON
Triggers persistent, cytokine storm
, fever after dengue,

Think HLH if:
• Fever > 7 days
• Ferritin very high
• Cytopenias
• Organomegaly

Need urgent Dexamethasone to start with ,and plus etoposide if needed ( already written ) .

If a dengue patient is unwell after Day 5, it is no longer the virus ,
it is either fluid overload, bleeding, infection, myocarditis, or organ failure or HLH .
Management shifts from “dengue protocol” to “complication control.”

Amjad Taqweem online medicine- ATOM

19/06/2025

The pancreas is the primary source of insulin, particularly the beta cells within the islets of Langerhans
Recent research indicates that the brain also produces and utilizes insulin.
Specifically, certain brain cells, including those in the hippocampus and olfactory bulb, have been found to synthesize insulin.
However, it's believed that the majority of insulin in the brain parenchyma originates from the pancreas and enters the brain through the blood-brain barrier or as it’s called the BBB.

Scientists say that the brain actually make insulin.

New research reveals that the brain, long overshadowed by the pancreas in insulin production, is a significant source of the hormone itself.

Though dismissed for decades, studies now confirm multiple types of brain cells — including neurogliaform cells, neural progenitors, and stress-sensing neurons — produce insulin independently of the pancreas.

These cells are located in regions tied to memory, growth, and even appetite control. For instance, insulin from the choroid plexus, which creates cerebrospinal fluid, has been shown to influence food intake by altering hypothalamic circuits.

While brain-derived insulin doesn't regulate blood glucose like its pancreatic counterpart, it appears essential for neural health and metabolic regulation within the brain.

The discovery has deep implications for understanding conditions like Alzheimer's, often dubbed “type 3 diabetes,” due to the brain’s insulin resistance and reduced glucose usage. With brain insulin tied to appetite, cognition, and aging, this emerging field may reshape how we understand and treat neurodegenerative diseases and metabolic disorders alike.

learn more https://theconversation.com/despite-what-you-learned-at-school-insulin-isnt-just-made-in-the-pancreas-256264

26/07/2024

My Notes On

specific mention in relation to eGFR


Reference:
Robbin
Davidson
Tara V Shanbag
Lippincott

28/04/2024

Highly Knowledgebal & Very Well Elaborate Research Methodology,
Medical Researcher Aspirant's Must Watch..

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