00 : 00 / 05: 00 (Preview)

This discussion has ended. Watch the recording on Medflix app,

Symptomatology of Acute Febrile illness

Oct 11 | 1:30 PM

Acute febrile illness is the leading cause of overcrowding in hospital wards during the monsoon season, and with the rise in viral illnesses, it is critical that we grasp the symptomatology to the point where we can diagnose without ordering lab testing (Not completely avoid but postpone few days to reduce lab load). Let us attend this symposium and learn some intriguing topics from Dr. Shah, who is enthusiastic about teaching and has a high presence and skill for communicating concepts.

[Music] good evening everyone and uh welcome back to a super pac week at netflix uh i'm dr nivedita and on behalf of team netflix i welcome you all to today's session today we have with us a very well-known physician dr tushar shah and by his first profession he's a consulting physician at critical hospital at juhu mumbai but sir has also published his poems a collection of poems and he's also published an anthology of humorous quotes related to medicine and i think this humorous part of sir reflects in the fact that he was a finalist for the great indian laughter challenge thank you so much thank you um and uh thank you netflix actually also for inviting me this is my first talk with matrix and i hope that there will be more to come uh today we're discussing acute febrile illness is symptomatology uh i do not do ppt's there are no slides to present so i would be glad if you guys could have a notebook and pen at hand just in case you find some points interesting [Music] william osler was a canadian american physician a clinician at heart and he once said and that is this is my favorite quote in the world of medicine even said listen to the patient the patient is telling you the diagnosis but we have lost that patience to listen to the patient and hence symptomatology suffers uh it is said that on an average a physician will interrupt the patient's case history in about 11 seconds so i think that needs to change because in acute febrile illnesses especially about 70 percent of the time you can hit the correct diagnosis by listening to the patient well so let's discuss acute femoral illnesses and uh the differential diagnosis from the on the basis of symptomatology in monsoon the common acute female illnesses that we are seeing currently as of now uh are malaria dengue occasionally leptospirosis and of course influenza and covalent and chikungunya these are the illnesses that we see and uh often one has to be differentiated from the other and how do we do it so i will not talk about one disease at a time i will talk about two diseases at a time so that you can you can know how to differentiate and get the correct diagnosis based on symptomatology let's discuss the two more common ones currently which are non-respiratory common ones malaria and dengue both mosquito bone are different mosquitoes malaria and dengue can be fairly easily differentiated from each other both are of course illnesses that we are seeing more commonly in the monsoons the principal differentiation comes from fever and pain in these illnesses in malaria as you all know very well the fever usually comes once or twice a day for a short period of time say one or two hours and is high grade at onset in dengue the fever again is high graded onset but is fairly continuous suppressed only by antibiotics to begin with so both fluids are high graded onset malaria and dengue but malaria is a shorter fever in the day and dengue is a continuous fever in the day both can have chills so we know that classically malaria has more rigors than dengue both can have risers both can have chills and this is not a very important differentiating feature but that classic peroxism of greiger short period followed by fewer slightly prolonged period followed by profuse sweating the classic characterism of malaria you all know about besides fever the other feature which is very important to differentiate malaria and dengue at the very beginning is the pains malaria has two distinct pains one is headache the other is lower back dengue has three pains myalgias which are very very prominent arthralgias which are less prominent than mild years and orbital or retro or vital pain these three are the typical pains of pain so if the patient has headache packing without any limb pains then dengue becomes unlikely so this so fever and pain therefore are fairly uh distinctive symptoms to differentiate between malaria and dengue you really can't go very wrong in in distinguishing between these two illnesses having said that when we make rules we must understand that rules have exceptions so you can't dogmatically say that this has to be there that you can't get uh myalgias in malaria you can't get myasia malaria too so this is about distinguishing between malaria and dengue the basics at the onset of fear high grade fever short duration per day in malaria prolonged in dengue pains headache and low back ache in malaria generalized myalgia arthralgia and retro orbital pain in dengue so this is important now between dengue and say enteric fear both of uh you all know that antique fear also has a continuous fear like then he has has but we know that entry fever has low grade fever at onset and a step ladder pattern the fever steps up gradually but in dengue there is a high grade fever onset and the fever steps down gradually and so on so that is the basic difference in the fever entry fever though it is called enteric may not have gi symptoms at onset so all these three illnesses illnesses malaria dengue and entry fever may not have localizing symptoms at onset when i say localizing symptoms i talk about say dysuria and uti or diarrhea and gastroenteritis or cough in respiratory infection so these three illnesses malaria and drink may not have typical systemic localizing symptoms in entry you may get some bloating in the mall in the rt onset some constipation at the onset some nausea at the onset but generally gi symptoms in the first two three days are absent and hence entitled is difficult to diagnose at the onset of the illness but if you think of intrigue just think of this low grade continuous fever without localizing symptoms and onset you have to consider enteric as a different diagnosis low grade continuous fever and onset how many diseases cause such fever low grade continuous without localizing symptoms not many so think of entry when when you have such fever now that is about three uh fairly well known diseases now let's come to these illnesses versus leptospirosis leptospirosis also causes high grade illness at the onset leptospirosis like dengue has significant myalgias and significant retro or vital pain both of them left to have conjunctival suffusion when i say suffusion i mean redness without excitation that is the the term given is suffusion so both lepto and dengue have fairly continuous high grade fever myalgias retro orbital pain this this differentiation now becomes very important here examination and investigation help more than anywhere else differentiating between lepto and other illnesses especially lepto and dengue here cbc for example will show leukocytosis in leptospirosis and leukopenia in dengue so lepto is a very uh important disease to diagnose early because because this is a lethal disease if unattended you have to diagnose very quickly so that is about leptosymptomology in very brief now we come to the two respiratory illnesses that we are normally encountering which is of course 19 and influenza both these cause fever with respiratory symptoms now we must remember that in the first wave of uh ovid 19 we often got fever without respiratory symptoms in the first three or four days fever was there respiratory symptoms were not there and fever was low grade to begin with and then turned the tide and became hydrated now in the second wave and thereafter we are seeing fever with respiratory symptoms or sometimes respiratory symptoms without fear so how do we think of overweight the give away symptoms the pathognomic symptoms as we know are an austria and loss of taste a juicia amos with atucia do not always occur at the onset of the infection meaning the patient have respiration they may have respiratory infections and fever you are treating as say influence or a common cold and then on the third or fourth day suddenly the patient loses smell or taste and that is when you realize i have missed over 19 so far and then you get the rtpcr currently if any patient comes with fever low grade or high grade continuous or non continuous but with respiratory symptoms both nasal and throat you must at the very beginning of a less think of code and get the rtpcr done because early diagnosis means that in the young patient you can isolate them quickly and in the older patient you can not only isolate them but offer them therapy now that we have antibody cocktail for example as a statement for early covet in patient patients with comorbidities you can you can treat them quickly so thinking of over quickly even when influenza is in the air even when um kovit is declining in numbers you have to do the rtpcr in patients with fewer and respective symptoms the only exception i would say here is if the patient has had a poor in the past the chances that this fever and kavanagh and golden cough will not be covered are high but if the patient had full vaccination in the past they do not have immunity to getting a breakthrough infection so don't let vaccination be the criterion for thinking that this may or may not be good uh influenza flu or influenza has four symptoms and to diagnose influenza confidently all four must be present nasal symptoms throat symptoms severe body ache and of course fever all four if present severe body ache is not a feature of orbit 19. in covid you get more malaise patient wants to just lie in bed body ache is a feature of influenza so between these two again body it helps influenza has four symptoms nasal symptoms runny nose block nose sneezing throat symptoms throat fever which can be high graded onset whereas fluid often gives low grade fever and of course severe body exceed your body which oh it does not have so these are the two respiratory illnesses that you can you can distinguish from each other fairly confident now let us talk about some fevers which are not these common monsoon like illnesses not the endemic trees uti uti has one very interesting feature uk as you know is upper uti lower has burning maturation increased frequency urgency and sometimes fear sometimes your lower utm significant numbers do not have fear at all upper uti in contradiction to lower utility in contrast to rpi has high grade fever strikers and sometimes no urinary symptoms now this is one problem with pyelonephritis upper uti when we say we are usually talking about something called pyelonephritis myelonephritis is typically characterized by fever risers without lower urinary tract symptoms it may have pain as a more prominent symptom in the flanks but increased burning increased frequency pain during which duration stranguley are typically absent in hylonephritis so when do you think of myelomethane on history daily if a diabetic patient comes with high grade fever and rigors don't think of malaria don't think of dengue the first thing that you think of is myeloma is in a diabetic patient with fever and dryness the second thing that you think of in the diabetic patients you're like is this leg cellulitis these two are the most important uh manifestations of infection in a diabetic patient when there is fever and risers in pyelonephritis one very prominent symptom is vomiting so if there's fever with risers and vomiting and the patient is diabetic you can be fairly confident that this patient is why is it important to diagnose or suspect is early it is important because this patient has to be hospitalized all upper uti if diabetic usually will end up in the hospital earlier the better so don't miss this diagnosis of paralympics cellulitis is another very important diagnosis meaning fewer with risers in a diabetic patient sometimes they will not see their legs and you have to if you are on a telephonic call or a video consult you have to see the legs or while examining the patient which is wearing a long study and you will not you might miss raising and seeing the shins look at the legs of any patient with high grade fever and rigors especially if the patient is diabetic do not miss cellulitis simple to diagnose the visual diagnosis you cannot miss it and hence therefore becomes very easy to treat okay so this is about how do you diagnose pneumonia there are two forms of pneumonia as you know typically typical typical ammonia is caused by the commonest atypical is not chlamydia not legitimate it is mycoplasma communist bacterial pneumonia is pneumococcal bacterial pneumonia if you have between atypical and typical typical causes higher fever more cough often rusty scooter meaning the patient will say that this is colored the course is often some acute meaning patient can present even after days of fear there is cough but may not have much expectation and there are more systemic symptoms in atypical more body more malaise than in typically so atypical temperatures are not difficult what will typically happen is that you will get an x-ray done because the patient had fever head cough or pain or occurred pain and you get an x-ray done when you get the accelerator you will chemotherapy is rusty sputum typical more likely high grade fever risers typically more likely systemic symptoms low grade fever slightly more indolent or prolonged atypical more likely one very classic symptom of pneumococcal pneumonia is rigors on day one and thereafter no ideas very classic symptom of pneumococcal pneumonia which you know is also characterized by rusty so pneumonia you can diagnose easily but differentiation between atypical and typically also important because sometimes you may not be able to do tests for microplasma which is an atypical and whose treatment is different the antibiotic choice is different than in typical one the another infection that i would like to talk about is amoebic liver axis often missed as a diagnosis simply because we do not examine the patient in the in the right hypocrite very very correctly now missing in america labor abscess causes a lot of increase in suffering of the patient we cannot allow ourselves to miss us immediately absence occurs more commonly in the relatively young less than 50 than in the older it occurs more commonly in alcoholics than non-alcoholics and the patient has history of travelling often travel and eating a lot of outside food often the patient may give history a three percent operation will give history of having amoebic descending meaning loose emotions with mucus few days or weeks ago this history if you can catch then it's a it's a very good history to catch because this history will mean that now you will suspect a mentally ill absence even more maybe colitis receives the maybe clever abscess that ominous colitis may or may not have been symptomatic amoebic liver absence has fever tigers and right hypochondriac pain if you ask them you will have to do a leading question here meaning you have to ask the patient when i touch you when you touch yourself or when i touch you do you get pain if you are doing a video consolation for example ask the patient to touch themselves at the right hypochondrium level poke their finger in the right hand or even better still thump their right hypochondria and this something will cause excruciating pain in the patient in the midvale has made your abscess when you are physically seeing the patient remember one examination of the abdominal system is the thumb thump the patient in the right lower rib cage and that will elicit significant tenderness if the patient has ammunition it's a beautiful sign to elicit another infection that i must tell you about which can cause acute fever and which is often missed and that is acute calculus cholesterol this is a beautiful symptomatology and you cannot miss this symptom patient says that usually i get pain [Music] in the epigastrium or on the right side of the upper abdomen which lasts for one hour or so since a few years meaning i get episodic pain lasting one hour or so in epigastrium or right hypovolem about an hour after my meal especially if it's a restaurant or a heavy me and this pain subsides after that the pain when it occurs is severe but it subsides after an hour but today not only i have that pain but that pain has lasted more than four hours and i have fever with riders currently now this is a very classic presentation of acute calculus scoliosis not every patient will give you past history of not every patient with your past history of gallstone colic what i described previously in the previous months patients not every patient will give you that so in patients who don't give you that kind of history then of course the diagnosis will be a little more tricky but if the patient says i have pain in the abdomen a big gastric right above fever right sometimes vomiting then think of calculus acute kind of school decisions again has to be hospitalized this patient cannot miss this diagnosis symptomology will have given you the diagnosis and you have to admit the patient another acute do remind me i have missed one mosquito bone less which is very important but i'll come to that later one more abdominal disease we have discussed pylon nephritis or maybe your abscess calculus polarized studies one more important abdominal disease that is uh that must be thought of in fever is appendicitis now acute appendicitis has three important symptoms pain followed by nausea followed by fever this triad i don't know if the pain occurs first in the very umbilical area not in the right apricot very umbilical not in the right iliac fossa very umbilical area or epic action then the brain gradually over hours travels down and localizes in the right lower quadrant or uh right here fossa that is the pain then we have absolute pain nausea or vomiting comes and after nausea you get fever so fever is a later symptom of acute appendicitis so if a patient comes with abdominal pain and fever at the same time think of other things other than two different sites one more inter-abdominal uh fever that i want to talk about which is commonly missed and that is acute diverticulitis as you know diverticulosis can occur anywhere in the gi tract diverticulosis of those pouches and these diverticuli are most common in the sigmoid colon diverticuli increase in size and numbers as age progresses older people have more diverticulosis is an acute event in a patient with pre-existing diabetic kilos diverticulosis how will the operation of diverticular is present patient typically the diverticulitis is in the sigmoid therefore the pain is in the left lower quadrant left eyelid fossa so if a patient comes with fever pain in the left eyelid fossa and gi symptoms then this is you should think of must think of diverticulitis the pain will be localized to the left people in diverticulitis there is constipation not diarrhea in sigmoid diabetic legs in diverticulitis sometimes you get what is called as obstetrician obstetrician means constipation with obstruction of the of the gut so the patient says i cannot pass to and i cannot cannot even pass latest that is the kind of constipation they get that is diverticulitis then there is renal colic related infection or pain remember urethric stone typically does not cause fever so that is one way to differentiate appendicitis with the right urethric stone if there is a right iliac fossa pain severe pain in a young person there are two most important stone in appendicitis in stone you will get pain in stone you will get vomiting just like appendicitis but in stone typically you will not get fever fever even if it comes down uti will be much much later so if viewer comes stone is an unlikely diagnosis at the beginning of the page so i think i have covered uh some of the gi almost all of the gi acute infections if i have missed something we'll discuss that now let us talk about chikungunya we have seen more chicken this year than i have seen in any any previous year in in my practice as you know again a mosquito boat illness uh chikungunya is so easy to diagnose that sometimes there is no differential and luckily for us the symptoms are so easy and science are so easy that the absence of a good diagnostic test is not missed i'll explain chikungunya when you hear the history suppose you're taking only a telephonic history when you hear the history of them then the patient will say patient has high grade fever sometimes and patient will say i have pain now you know that dengue has pain you know that lepton has pain now what kind of pain is this arthritis not myalgias very important chikungunya has joint pains it's a joint disease it's an arthritis you don't see myelias in chikungunya let anybody say otherwise let the textbook say my use the word no there is arthralgia predominantly and you must not consider the diagnosis if the predominant pain is not joint pain patient has arthritis special arthritis is bare more in the appendicular skeleton not in the axial scale meaning not in the spine not much in the hip joints or the shoulder joints but in the hands elbows knees ankles feet and this joint pain is both migrated in the sense that we shouldn't say okay right and this pain is meaning the patient says my left hand hurts more than mine right i can do something with my right hand but can't do anything with my neck the leg pains knee ankle pins are such that the gate is affected so if a patient comes to your clinic sometimes you can diagnose the patient at the door by the way the patient walks in if the patient says i have high fever since yesterday and you see the patient walking in limping has to be supported by a person your diagnosis is there for you you don't need any taste and this is chicken arthralgias may not be to begin with associated with swellings of joints meaning arthritis may be missing in the beginning but almost always some joints will get swollen in chicken another symptom of chicken episodes fear and joint means is a rash many patients will complain of rash sometimes the rash is at the onset of illness sometimes it comes after the fever grocery fever typically in chikungunya is short lasting rarely will you exceed three days you will rarely exceed three days in chicago so the patient has fever which is short and joint pains which are long duration then you know that your diagnosis is chicken the only differential diagnosis of any importance is reactive arthritis sometimes loosely called wheaters syndrome as you know liter syndrome is a post infectious arthritis where the patient after say about of gi tract infection gets joint pains and and and sometimes fever liter cinnamon affects the axial skeleton also especially the lumbosacral area and the hip joints say sacroiliac joints and they've got so exhausted involvement is an important feature of reactive arthritis chikungunya thought not difficult diagnosis at all clinically has some tests and now we have this test called chikungunya pcr which within the first five days can diagnose chicken money might do if you do the pcr just like you do the rtpcr of covet90 uh this pcr is done in blood not in any swamp so that is about chikungunya uh i think i will finish my didactic here and i i would love to have an interactive 7 34 we i think have some time and i would love to have some data some interaction if you have any questions grieving sir thank you uh sir i would request you to answer me regarding the throat pains which we see in urti lrti and covet the type of pain typically which has so how can we differentiate it because every patient wouldn't be susceptible in gps to go for artificial iot instantly within a day or two and then we have to treat it like you know a flu cold flu influenza type but early diagnosis as i said is early line of treatment so please can you help it over at me this is what i can guide you with throat pain which is associated with odynophagia meaning swallowing difficulty is not a feature of either poverty or influenza road pain with swallowing difficulty is a feature of safe severe pharyngitis pharyngeal tonsillitis sometimes uh you know something like infectious mono nucleus results so if there is throat pain with odinophilia do not think of influence if there is thought irritation or dryness of throat then covet becomes possible they have more that kind of throat irritation or dryness where they have to save water frequently so i think that is the basic differentiation between the two throat pain without cough is a very important feature negating over and influence influence if there is any throat irritation or even pain cough has to be there same with covet cough has to be there but if there is throat pain and no cough think of translators because translators does not cause of infectious mononucleosis uncommonly or rarely causes cough so both are of course through the infection parenchy is translated so you must think of rhinophysia and cough as symptoms to ask for in a patient with throat discomfort i hope that partly at least answers your question hello hi sir this is dr avinash what should be my first choice of antibiotic if a patient landed with the fever cough cold into my opd before like before going to investigations like what should be yeah so i will ask a good question because this is extremely important for me to answer do not give antibiotics in respiratory tract infections to begin with most respiratory attack infections are viral and we do not use antibodies in viral infection we we make this blunders mistake so often do you know that sinusitis or rhino sinusitis is more commonly viral than bacteria similarly pharyngitis is more commonly viral than hold your horses have some patience encode people have started giving antibiotics left right and center as it through my syntax reciting pr are insulting our science we are insulting our science when we start giving antibiotics without without uh proving bacterial infection so i'll just tell you this that if you want to give antibody empirically where you don't have any investigations let the patient have bad cough fever with greenish scooter and then you can think of giving an antibiotic empirically without proof but if you just give symptomatic treatment you will save the patient a lot of hardship in in the form of side effects you have seen code right you have seen escrow isn't being being given in code and you've seen that 50 percent of 50 percent of covet patients uh who are given azithromycin developed area due to acetaminophen so it is a ridiculous thing so let's not let think of symptomatic that we don't think of antibiotics my suggestion like if the patient is having uh an additional symptoms of like a nausea one thing generalized body uh in addition to these symptoms like what should be my further proceedings with the patient dealing i don't know whether you heard the lecture from the very beginning but if you can diagnose dengue become the basis of body ache or leptospirosis on the base of some other symptom you will know what investigation is to do and therefore you'll be able to read i think you are coming from the uh from a point where you said i will not do investigations and i am going to just read as it is fair enough but antibiotics because you have nothing else to give specifically to the patient and not the answer antibiotics generally cause more harm than benefit in most situations you cannot give antibiotics unless you prove a bacterial infection it is very important to refrain i know that it is not easy because you see antibiotics even being given by your bosses colleagues yes don't feel afraid of not giving antibiotics be braver don't use antibiotics please that is a request don't do antibiotics ad hoc empirically uh in every patient that you have for people can't do that good evening doctor here certain excellent lecturer i must say that you have covered in 40 minutes and everything that requires an accurate travelness and you rightly started and quoted william osler and probably follow him and clinics that's what is very apparent so excellent wonderful take home messages i was want to add one or two points uh being a practicing physician one is that the problem comes when patient comes with partly treated with antibiotics or antibiotics and second is the mixed infections when things are not going the right direction for probably think of both that was one point that's it otherwise and wonderful excellent lecture and truly in such a short time i don't think anybody could have done it better than yours thank you so much about the mixed infection part so whenever the patient is told that patient has malaria and typhoid together of course you have to take it with a pinch of salt or maybe even a table tablespoon of salt uh when this is told to the patient look into the file of the patient you will find a vidal test now vidal is one of the worst tests in the whole world meaning it's a harmful test harmful as a test because it misdiagnoses and patients are led to believe that they have typhoid even when they may have meningitis or tuberculosis or ammunition uh so two diseases at the same time should not be diagnosed as far as possible and this usually happens on the basis of injury what you have to do in fact is if the patient has rapid millennial antigen positive and dengue ns1 positive both then you should have doubt the laboratory which is doing the test and repeat the test dengue is one mosquito it is egyptian malaria has one mosquito anopheles you cannot have two mosquitoes biting a patient the same time that's a quite degree of bad luck i would say so do not diagnose two things diagnose one that that is very important uh yes sir thank you so much for your comments yeah another thing sir you are very well known for your sense of humor and we have seen you also in the laughter channel so have some to our audience if you don't mind this is an interesting question based on our topic today can cns infection present as acute female illness of course it can meningitis will be but cream injuries can present as an acute favorable illness so you must in any patient who has fever with vomiting you have to think of meningitis and look for next steps on examination look for mental optimization look for focal logical deficit like even diplopia etcetera so yes you must think of many that is though it is now becoming rarer definitive test for typhoid is of course blood culture mixed infection viral bacterial mixed infections there are secondary infections not mixed infections so you may get a viral over pneumonia first and after that you may get a secondary bacterial pneumonia but a beginning mixed infection where you get airborne virus plus bacteria they meet each other and come inside our body is extremely rare hello lisa hi mr hello sir like you said that in viral diseases we cannot give antibiotics so what will we give them are you very uncomfortable not giving anything are you very uncomfortable just giving symptomatic treatment why the discomfort no sir why the discomfort of not doing harm when you don't give many medicines you are basically not doing harm one of the principles of medicine is primum non rhyming no sere is a phrase which means first do no harm this is one thing that you have to learn as one of the primary uh therapeutic actions we cannot do good all the time but we can avoid harm all the time so don't feel helpless foreign this is not an argument to make but just because you can't give anything they're forgiven no the patients are becoming knowledgeable the patients are becoming educated even they know that medicines can go wrong prescriptions can be incorrect you don't have to give something people will use steroids because why it's a viral infection i can't give antibiotics fever is there let me give steroids steroids and antibiotics are to be chosen in very few cases and appropriate yeah you give some time learn how to do symptomatic treatment and i think you'll be fine you your success and it will be very hard okay sir thank you in the most of the case of febrile illness uh whenever i examine the patient the first and main symptom is fibril condition but after that three to five days there may be the more than chikungunya is positive and then uh their uh c reactive protein crp is also high so what is the chill and crp what is the right situation for them okay first of all when you said the first two three days you have fever then pcr comes positive are you trying to say that these patients did not have joint pains of chikungunya did you suspect chikungunya based on only fever or on joint pains joint pain fever and chills the three combination so when fever comes with joint pains without muscle pains only joint pains then your diagnosis is very very confident and i do not do pcr if uh if the diagnosis is confident the patient don't know what this diagnosis is this is sometimes we do pcr only for satisfaction of the patient and uh crp again i'll just quickly tell you as an arthritis can be very high you can get crb more than 50 100 something 150 in chicago very unlike dengue but this year be not as high as in chicago so if you do cr which i don't always do but if you do crp then it will be very high thanks good evening my question is as you said vital test is not correct to diagnose it so can you say that what i mean in [Music] first day of sleep first day you don't have to wait for lunch complete [Music] your students itself to do [Music] ask today why is it positive on the first day because in the when fever starts patient has bacteria but bacilli in the blood so blood culture will pick it up very fast you don't have to wait for any days and vidal somebody asked why is vidal not to be done vidal is not sensitive vidal is not specific especially in the very poor and vidal is false positive in so many infections not bengita not just dengue not just kovet vidals falls positive in normal people if all of us sitting here he has no meaning so as you said but in some rural areas the culture i mean the test of culture will be like little bit expensive for the patient and some in some areas it is not available proper source is not available to do it so we can go for any empirical treatment for that so blood culture is available in every city semi-urban urban area in the in the country every the blood culture technology may not be the best in every lab but it is available in every center if your center does not have it it will be sent to some other center so let us not shy away from sending blood culture in entry fever because we have not done it it is not a habit with us we resist it and we fall back upon that very convenient vidal test don't do that please send culture you will be so much more accurate in your diagnosis and you will not miss other diseases vidal makes you miss other diseases it makes you miss pneumonia malaria dengue meningitis everything vidal makes you miss vidal has to be abandoned i am wondering why it has not been banned it should be banned and not allowed typhoon igm is with a bite thank you so much sir this was a really informative and very educative learning session for all of us um thank you so much for coming on netflix and we hope you come back again with us and host further sessions uh for those yes i cannot disrespect the request of dr martial they say so i just recite a very short poem uh you know how the differences opinion within physicians are so large like some most of them like vidal i don't like most of them like to give i [Music] foreign thank you so much

BEING ATTENDED BY

Dr. Darius Justus & 1160 others

SPEAKERS

dr. Tushar Shah

Dr. Tushar Shah

Consulting Physician at Advanced Multispecialty Hospital, Mumbai

+ Details
dr. Tushar Shah

Dr. Tushar Shah

Consulting Physician at Advanced Multispecial...

+ Details

About Medflix

Medflix is a new platform by PlexusMD, India's most active and trusted doctor community. On Medflix, you can discover live surgeries, discussions, conferences and courses from some of the top doctors and institutions across the world. Join clubs in your areas of interest and access hundreds of amazing live discussions everyday.