Pattayadoctor by Dr.Kijakarn

Category: Viral

  • PostExposure medicines(PEP) for HIV

    PostExposure medicines(PEP) for HIV PEP =Post Exposure Prophylaxis for HIV typically consists of a 28-day regimen. Common regimens include:

    Tenofovir disoproxil fumarate (TDF) 300 mg + Emtricitabine (FTC) 200 mg + Raltegravir 400 mg twice daily (preferred for most exposures). – Alternatively, TDF 300 mg + FTC 200 mg + Dolutegravir 50 mg once daily (if raltegravir is unavailable or contraindicated). – For higher-risk exposures, boosted protease inhibitors (e.g., darunavir/cobicistat) may be added. – Rationale: Guidelines (e.g., CDC, WHO) recommend these regimens due to high efficacy and tolerability. – Effectiveness:
    If initiated within 72 hours of exposure, PEP reduces HIV transmission risk by ~80%. – Adherence to the full 28-day course is critical for effectiveness. – Rationale: Early initiation and adherence prevent viral replication and integration. – Side Effects:
    Common: Nausea, fatigue, headache, diarrhea (usually mild and transient). – Less common: Elevated liver enzymes, renal impairment (with TDF), or rash (with integrase inhibitors). – Severe: Rare, but monitor for hypersensitivity reactions or lactic acidosis (with older NRTIs). – Rationale: Side effects are generally manageable; dose adjustments or regimen switches may be needed.

  • Norovirus summary from Mikai

    Norovirus summary from Mikai Leading cause of outbreaks of gastroenteritis worldwide (~50% of reported outbreaks in the U.S.). –

    Predominantly transmitted via fecal-oral route; also present in vomitus. –

    Spread by asymptomatically infected individuals and symptomatic persons before symptom onset and for weeks post-recovery. –

    Prolonged viral shedding in immunocompromised individuals. –

    Pathogenesis:
    Exact cellular receptors and attachment sites under investigation. – Infects mature enterocytes in the small intestine, leading to villous atrophy and malabsorption. – Incubation period: 12–48 hours. –

    Clinical Features:
    Acute onset of nausea, vomiting, diarrhea (non-bloody), abdominal cramps, and low-grade fever. – Symptoms typically resolve within 2–3 days; dehydration is the main concern. –

    Diagnosis:
    Primarily clinical; stool PCR for confirmation in outbreaks. – Rapid antigen tests available but less sensitive than PCR. –

    Treatment:
    Supportive care (oral rehydration, IV fluids if severe dehydration). – No specific antiviral therapy; vaccination not yet available. –

    Prevention:
    Hand hygiene, proper food handling, and disinfection with bleach (1:10 dilution) due to virus stability. – No post-exposure prophylaxis. Rationale: Norovirus is a significant global health concern due to its high infectivity, rapid spread, and lack of specific treatments. Supportive care remains the mainstay of management.