Sandbox:YK

Afib and Heart failure

Class I

"1.Control of resting heart rate using either a beta blocker or nondihydropyridine calcium channel antagonist is recommended for patients with persistent or permanent AF and compensated HF with preserved ejection fraction (Level of Evidence: B)"

"2. In the absence of pre-excitation, intravenous beta-blocker administration (or a nondihydropyridine calcium channel antagonist in patients with HFpEF) is recommended to slow the ventricular response to AF in the acute setting, with caution needed in patients with overt congestion, hypotension, or HF with reduced left ventricular ejection fraction(Level of Evidence: B)"

"3. In the absence of pre-excitation, intravenous digoxin or amiodarone is recommended to control heart rate acutely in patients with HF(Level of Evidence: B)"

"4.Assessment of heart rate control during exercise and adjustment of pharmacological treatment to keep the rate in the physiological range is useful in symptomatic patients during activity.(Level of Evidence: C)"

"5. Digoxin is effective to control resting heart rate in patients with HF with reduced ejection fraction(Level of Evidence: B)"

Class III (Harm)

"1. AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control (Level of Evidence: C)"

"2. For rate control, intravenous nondihydropyridine calcium channel antagonists, intravenous beta blockers, and dronedarone should not be administered to patients with decompensated HF (Level of Evidence: C)"

Class IIa

"1. A combination of digoxin and a beta blocker (or a nondihydropyridine calcium channel antagonist for patients with HFpEF) is reasonable to control resting and exercise heart rate in patients with AF (Level of Evidence: B)"

"2. It is reasonable to perform AV node ablation with ventricular pacing to control heart rate when pharmacological therapy is insufficient or not tolerated (Level of Evidence: B)"

"3. Intravenous amiodarone can be useful to control heart rate in patients with AF when other measures are unsuccessful or contraindicated. (Level of Evidence: C)"

"4. For patients with AF and rapid ventricular response causing or suspected of causing tachycardia-induced cardiomyopathy, it is reasonable to achieve rate control by either AV nodal blockade or a rhythm-control strategy (Level of Evidence: B)"

"5. For patients with chronic HF who remain symptomatic from AF despite a rate-control strategy, it is reasonable to use a rhythm-control strategy(Level of Evidence: C)"

Class IIb

"1. Oral amiodarone may be considered when resting and exercise heart rate cannot be adequately controlled using a beta blocker (or a nondihydropyridine calcium channel antagonist in patients with HFpEF) or digoxin, alone or in combination (Level of Evidence: C)"

"2. AV node ablation may be considered when the rate cannot be controlled and tachycardia-mediated cardiomyopathy is suspected (Level of Evidence: C)"

Fournier's gangrene

Physiologic Variables	High Abnormal Values				Normal	Low Abnormal Values
	+4	+3	+2	+1	0	+1	+2	+3	+ 4
Temperature	>41	39-40.0		38.5-39	36-38.4	34-35.9	32-33.9	30-31.9	<29.9
Heart Rate	>180	140-179	110-139		70-109		55-69	40-54	<39
Respiratory Rate	>50	35-49		25-34	12-24	10-11	6-9		<5
Serum Sodium (mmol/L)
Serum Potassium (mmol/L)
Serum Creatinine (mg/100/ml*2 for acute renal failure)
Hematocrit
WBC (Total/mm*1000)
Serum Bicarbonate (Venous,mmol/l)

Region	Gender	Incidence/100,000	Prevalence/100,000
Region 1	M	Incidence	Prevalence
	F	Incidence	Prevalence
Region 2	M	Incidence	Prevalence
	F	Incidence	Prevalence
Region 3	M	Incidence	Prevalence
	F	Incidence	Prevalence
Region 4	M	Incidence	Prevalence
	F	Incidence	Prevalence
Region 5	M	Incidence	Prevalence
	F	Incidence	Prevalence

Zika Prevention

How Long to Wait Before Attempting to Have a Baby in Zika Endemic areas
Presence of Symptoms	Women	Men
Zika symptoms	At least 8 weeks after symptoms start	At least 6 months after symptoms start
No Zika symptoms	Talk with doctor or healthcare provider	Talk with doctor or healthcare provider

Zika sexual transmission

For People Who Have Traveled to an Area with Zika
If you are pregnant	Pregnant women should not travel to areas with Zika. If you must travel to an area with Zika, talk to your healthcare provider.
If your partner is pregnant	Use condoms correctly, every time you have vaginal, anal, or oral sex or do not have sex for the entire pregnancy.
If you and your partner are planning a pregnancy	Discuss your plans for pregnancy with a healthcare provider to determine your risk and the options available.
If you or your partner are not pregnant and are not planning a pregnancy	Men - consider using condoms or not having sex for at least 6 months after travel (if you don’t have symptoms) or for at least 6 months from the start of symptoms (or Zika diagnosis) if you develop Zika. Women- consider using condoms or not having sex for at least 8 weeks after travel (if you don’t have symptoms) or for at least 8 weeks from the start of symptoms (or Zika diagnosis) if you develop Zika.

For People Living in an Area with Zika
If you or your partner are pregnant	Use condoms from start to finish, every time you have vaginal, anal, or oral sex or do not have sex for the entire pregnancy. It is also very important to see a healthcare provider to discuss your options during pregnancy
If you and your partner are planning a pregnancy	Discuss your plans for pregnancy with a healthcare provider to determine your risk and the options available.
If you or your partner are not pregnant and are not planning a pregnancy	Consider using condoms or not having sex as long as there is Zika in the area. If either you or your partner develop symptoms of Zika or have concerns, talk to a healthcare provider and follow the guidelines on the left.

Hand foot and mouth disease

Viruses	Serotypes
Coxsackieviruses	A2, A4 to A10, A16, B2, B3, B5
Echoviruses	1, 4, 7, 19
Enteroviruses	A71

HFMD

Infection	Presentation
Herpes simplex virus stomatitis	• Associated with high grade fever, acute gingivitis and oral ulcerations • The vesicles are small, grouped together and on an erythematous base • Absence of rash on palms and soles • A Tzanck test shows multinucleated giant cells and direct fluorescent antigens test can also help to differentiate hand-foot-and-mouth disease from herpes simplex virus infection
Herpangina	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Bacteremia and sepsis	Leucocytosis >15,000 cells/mL OR serum creatinene level >1.5 times baseline or abdominal tenderness and serum albumin < 3 g/dL
Chickenpox	Hypotension or shock, ileus, megacolon, leucocytosis >20,000 cells/mL OR leucopenia <2,000, lactate >2.2 mmol/L, delirium, fever ≥ 38.5 °C, organ failure
Measles	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Pharyngitis	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Stevens-Johnson syndrome or Erythema multiforme	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Henoch-Schönlein purpura	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Kawasaki disease	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Behcet's disease	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Pemphigus vulgaris	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline