40 years old alcoholic male presented at OPD, with the complaints of vomiting, Diarrhea, abdomen pain and abdominal fullness since 1 day, Physical examination shows normal finding. Routine stool test shows present of amoeba for that physician prescribed him metronidazole for 5 days but the very next  day this patient returns at emergency room with the chief complaints of nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath.

Based on the above case, what would be a reasonable initial hypothesis?

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3 years old female child comes to ED with abdominal pain, nausea, vomiting and hypotension. She has severe weight loss since 1 year of duration.Previously she was diagnose as transient hypoparathyrodism.

Her lab investigation shows Hb decreased ,cortisol <495nmol/L,Bp <110/70mmHg .Her thyroid function test –T3 & T4 increased TSH decreased  & TPO and TMO  is positive. fasting blood glucose is elevated.

On PE  her thyroid is 3degree enlarged .

What would be ur further investigation & wt is ur diagnosis ?????

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Winter vomiting disease is a stomach infection caused by a group of  highly contagious  virus called noroviruses (are small round structured RNA virus(SRSV) or Norwalk-like-viruses.)

Symptoms:

• Sudden nausea and projectile vomiting.
• Fever
• Water diarrhea
• Stomach cramps
• Headache
• Limbs pain

Incubation period 12-48 hours and still contagious 48 hours after symptoms have cleared .

Person  at risk?

Risk for any age and at any time to the year but more common in winter ,semi-closed environments such as hospital ,nursing homes, schools and cruise ships.

Spread of norovirus ?

It is spreads form person to person ,fecal oral route and get the virus form contaminated food and water ,particularly bivalve mollusks (oysters, mussels, clams, cockles and scallops).

Treatment

No specific treatment for the winter vomiting disease. Most people make full recovery within a few days. During disease course water loss from the body .This means you need to take plenty of liquids to replace body fluid loss.

If diarrhea is sever and persist  antidiarrhoeal drugs like loperamide can be used to ease the symptoms, while paracetamol can help aches and pains.

If dehydration is sever ,admit to hospital  for intravenous resuscitation.

Prevention of norovirus:

Personal good hygiene is the best method to protect yourself form this disease.

• Wash your hand after doing any work
• Disinfect surface that’s been contaminated with diarrhea or vomit
• Isolation of  patients
• Cleaners should wear gloves when disinfection washrooms and toilets

Passive immunity only for 14 weeks after acute infection .

Source:

1.www.netdoctor.co.uk

2. www.bbc.co.uk

3. en.wikipedia.org

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