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    MRCP II MADE EASY is one of the best Travel guide to take while in the Philiipinses as it explaina all the Tropical diseases econuiterd there. Many visitors think of it as a trivial ill ness but a second attack by a mosquito with a different serotype ( as there are 4 kinds ) may precipitate dengue Haemorragic Fever. This may lead to death unless the patient is treated in an ICU by an active Physician. The book is written by a Harvard trained Physician who is a Member of the Royal College of Physicians London ( MRCP ) and a Royal physician. The reason why Dehgue Haemorragic Fever is so dangerous is because the first infection has produced certain chemicals called non neutralising antibodies which accelerated th a proliferation of the virus in the macrophages ( the white cells whch protect us. It activates cytokines ( which is the napalm of the body designed to ber deployed in severe infection. It then activates an ancient pahtway called the complement system which is an ancient system which when unleashed is like the storm of bodily destruction in order to be the nuclear explosion which destroys all areas affected by the virus. Halsted has demonstrated that there is a dreop in complements in pateients with a poor prognosis. The third system it activates is the storm of cytokines which are like the tiger tanks of the body. This results in a bloody mess to frindly fire storm and the walls of the arteries are destroyed as well as that of the liver. In fact, the genome of the Dengue is so identical to the genomic structure of the Hepatitis C that liver cancer occurs 1 yeear aftewr 1 year whilst that of Hepatitis C which tkes up to 8 years to produce cancer. So there is fluid leakage from the pipes of the body ( the blood vessels ) that they leak. Fluid must be given and it should be controlled by assesing the fluctuation in the sivve of the inferiorr vena cava ( which supplies blood to the right side of the lungs after they hace been loaded with oxgen. So the poheart is pumpping a system which is relarively dry and fluid is every where. It is fatal to give frusemide as some would like to get rid of the effusion and not understanding the pahtology.. The fluid repletion is not only calculated and may be ascertained by a femoral venous line to the riight side of the heart at the level of the right atrium, fluid calculation may be performed. The critical care of the pathient reqires a person who has experience in correcting correctly vascular dehydration by means of the size of the IVC. As Petros Niyohannpopulour says , eyeballing is the most accurate3 way to asses ejection function ( or the strenght of the heart ) , eyeballing in response to breathing and compression is also an art which requires a monitored rather thatn a calculated model of fluid intravenous repletion. Since the pathology appears to be due to a storm of civil war and friendly fire , the new biollogisc may have a be a good adjuvant for the treatment during the critrical period which may last for 24 to 72 hours. After that the fluid is resorbed back into the blood vessels from the rest of the body and cardiological asseement is required as myocarditis and pericarditis occur duringf the period of resorption and may lead to a weak heart pushed into failure . this is not an uncommon problem and I seldom see patient with Dengue undergoing a a cardiological test. The book explains all this in laymans terms and my family loves it as each case is like a series from House MD. Please dont trivialize Dengue as it is a dangerous plague ready to infect the globe.

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