<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <!-- saved from url=(0041)file://\\Nazi\e\sol-end\eng-maghale-2.htm --> <HTML><HEAD> <meta http-equiv="Content-Language" content="en-us"> <TITLE>Professor Soltanzadeh</TITLE> <META http-equiv=Content-Type content="text/html; charset=unicode"> <META content="Microsoft FrontPage 5.0" name=GENERATOR> <META content=FrontPage.Editor.Document name=ProgId> <style> <!-- h1 {margin-bottom:.0001pt; text-align:left; page-break-after:avoid; direction:rtl; unicode-bidi:embed; font-size:14.0pt; font-family:"Times New Roman"; margin-left:0cm; margin-right:0cm; margin-top:0cm} h2 {margin-top:0cm; margin-right:21.75pt; margin-bottom:0cm; margin-left:0cm; margin-bottom:.0001pt; text-indent:-21.75pt; page-break-after:avoid; tab-stops:list 21.75pt; font-size:14.0pt; font-family:"Times New Roman"; } h3 {margin-top:0cm; margin-right:18.0pt; margin-bottom:0cm; margin-left:0cm; margin-bottom:.0001pt; text-indent:-18.0pt; page-break-after:avoid; tab-stops:list 18.0pt; font-size:14.0pt; font-family:"Times New Roman"; } --> </style> </HEAD> <BODY text=#000000 vLink=#ff0000 aLink=#0000ff link=#0000ff bgProperties=fixed bgColor=#ffffff leftMargin=0 background="foriegnarticle2_files/bg4 copy.gif" topMargin=0> <DIV align=left> <TABLE height=61 cellSpacing=0 cellPadding=0 width=706 border=0> <TBODY> <TR> <TD vAlign=bottom align=justify width=166 height=1><IMG height=140 src="foriegnarticle2_files/toppage3.gif" width=166 border=0></TD> <TD width=673 background=foriegnarticle2_files/bgew.gif height=1> <DIV align=left> <TABLE height=136 cellSpacing=0 cellPadding=0 border=0 width="613"> <TBODY> <TR> <TD colSpan=4 height=46 width="290"> <P align=center><IMG height=36 src="foriegnarticle2_files/Toptext7.gif" width=255 border=0></P></TD> <TD height=46 width="50"></TD> <TD height=46 width="45"></TD> <TD height=46 width="120"></TD> <TD colSpan=2 height=46 width="118"><IMG height=40 src="foriegnarticle2_files/inkscroll.gif" width=65 align=right border=0></TD></TR> <TR> <TD height=36 width="40"><a href="tamas.htm"><IMG height=30 src="foriegnarticle2_files/But8copy.gif" width=40 border=0></a></TD> <TD height=36 width="80"><a href="karhay.htm"><IMG height=30 src="foriegnarticle2_files/But7copy.gif" width=80 border=0></a></TD> <TD height=36 width="115"><a href="tarh.htm"><IMG height=30 src="foriegnarticle2_files/b1.gif" width=115 border=0></a></TD> <TD height=36 width="55"><a href="maghale.htm"><IMG height=30 src="foriegnarticle2_files/b2.gif" width=55 border=0></a></TD> <TD height=36 width="50"><a href="kongereh.htm"><IMG height=30 src="foriegnarticle2_files/But4copy.gif" width=50 border=0></a></TD> <TD height=36 width="45"><a href="talifat.htm"><IMG height=30 src="foriegnarticle2_files/But3copy.gif" width=45 border=0></a></TD> <TD height=36 width="120"><a href="moarefi.htm"><IMG height=30 src="foriegnarticle2_files/But1copy.gif" width=120 border=0></a></TD> <TD vAlign=bottom height=36 width="84"><a href="index.htm"><IMG height=30 src="foriegnarticle2_files/But10copy.gif" width=80 border=0></a>&nbsp;</TD> <TD height=36 width="34">&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR> <TR> <TD align=left colSpan=9 height=54 width="623"> <p class="MsoNormal" style="text-autospace: none"> &nbsp;</TD></TR></TBODY></TABLE></DIV></TD></TR> <TR> <TD vAlign=top align=justify width=166 height=180><IMG height=174 src="foriegnarticle2_files/toppage1.gif" width=114 align=top border=0> </TD> <TD width=673 height=180> <DIV align=left> <TABLE cellSpacing=0 cellPadding=4 width=587> <TBODY> <TR> <TD width="579"> <p align="left"><b><span style="font-family: Times New Roman"> <font size="5">FEVER</font></span></b><font color="#000080"><span style="font-family: Arial"><br> </span></font><span dir="LTR">&nbsp;</span></p> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber1" bgcolor="#4D7565"> <tr> <td width="100%"><span dir="LTR">&nbsp;<font color="#FFFFFF"><b>1&nbsp;&nbsp; IDENTIFICATION OF THE PROBLEM</b></font></span></td> </tr> </table> <p class="MsoBodyText" dir="ltr" align="left"><span dir="LTR"><b>1.</b> Fever is due to a normal reaction of the body in its fight against chemical, physical or microbiological (bacterial , viral , parasitical ) attack&nbsp;&nbsp; . When fever exceeds 39C (<b>rectal</b> <b> temperature</b>) ,&nbsp; it must be treated , because it can be dangerous for the child (e.g. by causing convulsions , dehydration).</span></p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">Fever is a sign for which a cause must be sought and treated. <b>One must</b> <b>always consider</b> malaria , proof of which need not be available before&nbsp; beginning specific treatment in an endemic or hypoendemic zone , or in the case of a recent traveller in such a zone in the previous 1 to 4 years.</p> <p class="MsoNormal" align="right" dir="RTL" style="text-align:left"> <span dir="LTR">One must always make an examination and take a complete history and be sure that all possible causes of fever are investigated.</span></p> <b>2.</b> <b>Essential diagnoses</b></p> <b><span dir="LTR">&nbsp;&nbsp;&nbsp;&nbsp; -<font color="#000080">malaria;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -meningitis;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -diarrhoea and dehydration;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -gastrointestinal infection: e.g. salmonella , shi gella , E. coli;</font></span></b><br> <b><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -other intra-abdominal infections , e.g. peritonitis , appendicitis;</font></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -pulmonary infection;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -ENT infection;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -urinary tract infection;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -site of infection in the skin , eyes , muscles , joints , bones;</font></span></b><br> <b><span dir="LTR"><font color="#000080">&nbsp;&nbsp;&nbsp;&nbsp; -beginning of measles or other childhood contagious disease.</font></span></b><p><br> <span dir="LTR"><b>3.</b> <b>Complications to look for and prevent:</b></span><br> </p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-left: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol"> <span style="font-style:normal; font-variant:normal; font-size:7.0pt; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span> <span style="font-style:normal; font-variant:normal; font-size:7.0pt; font-family:Times New Roman">&nbsp; </span></span><span dir="LTR">Convulsions</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-left: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol"> <span style="font-style:normal; font-variant:normal; font-size:7.0pt; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span> <span style="font-style:normal; font-variant:normal; font-size:7.0pt; font-family:Times New Roman">&nbsp; </span></span><span dir="LTR">dehydration (which can occur even without diarrhoea or vomiting).</span></font><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></p> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber2" bgcolor="#4E7864"> <tr> <td width="100%"><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;</span><span style="font-style:normal; font-variant:normal; font-size:7.0pt; font-family:Times New Roman; font-weight:700"><font color="#FFFFFF">&nbsp; </font> </span><font color="#FFFFFF"><font size="3"> <span style="font-style:normal; font-variant:normal; font-family:Times New Roman; font-weight:700"> 2&nbsp;&nbsp; </span></font> <span style="font-style:normal; font-variant:normal; font-weight:700; font-size:7.0pt; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span dir="LTR">HISTORY AND PHYSICAL EXAMINATION</span></b></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>Take the rectal temperature</b> and record it; if it is more than 39C , undress the child wrap him in a damp cloth and get him to drink.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>Question to the accompanying person:</b> any complaints? such as recent vaccination?</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>Weigh the child</b> , evaluate his nutritional state enter it in the health record or card.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>Examine </b>the whole child: always look for symptoms of meningitis , especially if there is any suggestion of convulsions.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">If possible , <b>take a thick film</b> and if appropriate begin ant malarial treatment.</p> <h2 dir="LTR" style="margin-left:0cm">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </h2> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber3" bgcolor="#4E7864"> <tr> <td width="100%"><font color="#FFFFFF"><b>&nbsp; 3</b><span style="font-style:normal; font-variant:normal; font-weight:700; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span dir="LTR">TREATMENT</span></b></font></td> </tr> </table> <p class="MsoBodyText" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>&nbsp;1.</b><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span><span dir="LTR"><b>In&nbsp; all cases ,</b> even if there is no precise diagnosis:</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <font color="#000080">a)<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></font></b><font color="#000080"><span dir="LTR"><b>administer at the same time:</b></span></font></p> <p class="MsoNormal" dir="LTR" style="text-align:left;text-indent:18.0pt; direction:ltr;unicode-bidi:embed"><b>&nbsp; aspirin,</b>&nbsp;&nbsp;&nbsp; 50 mg/kg/d in 3 doses</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; and <b>chloroquine,</b> 10 mg/kg/d in one dose, for 3 days;</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; or <b>mefloquine,</b> 25 mg/kg/12 hours,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; in 3 doses of 12.5 mg/kg,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 7.5 mg/kg and 5 mg/kg, respectively, once,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp; or halofantrine, 25 mg/kg/12 hours , in 3 doses , once , depending on the local chloroquine resistance pattern;</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <font color="#000080">&nbsp;b)<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span></font></b><font color="#000080"><span dir="LTR"><b>if the infant is not conscious , </b> </span>give :</font></p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; inject able quinine, </b>25mg/kg/d IM in 2 doses</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp; or <b>inject able chloroquine</b> , 5 mg/kg/d IM in 1 or 2 doses;</p> <p class="MsoBodyText" dir="LTR" style="text-align:right;direction:ltr;unicode-bidi: embed">depending on the local chloroquine resistance pattern , being particularly careful about sterility when injecting (risk of necrosis);</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; c)<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span></b><span dir="LTR"><b>if the child is conscious: </b></span> get him to drink:</font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>2.</b><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span><span dir="LTR"><b>a) If the child is having convulsions</b></span>:</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>&nbsp;&nbsp;&nbsp;&nbsp; diazepam,</b> 1 mg/kg/dose , by rectal tube or IM (see <b><u> convulsions</u></b>).</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>&nbsp;&nbsp;&nbsp;&nbsp; b) If the child has had convulsions:</b></p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>&nbsp;&nbsp;&nbsp; diazepam,&nbsp; </b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;4mg/kg/d in 2 doses,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp; or <b>Phenobarbital,</b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 6mg/kg/d in 2 doses,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp; orally for as long as the fever persists.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp; <b>c) In addition geve an intramuscular injection&nbsp; of :</b></p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>&nbsp;&nbsp; inject able quinine,</b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 25mg/kg/d in 2 doses,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp; or <b>inject able chloroquine,</b>&nbsp;&nbsp; 5mg/kg/d in 1 or </p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;2 doses,</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">depending on the local chloroquine resistance pattern, being particularly careful about sterility when injecting (risk of necrosis).</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">Then give oral chloroquine , mefloquine or halofantrine (depending on the local chloroquine resistance pattern ) as soon as practicable , and institute a programme of antimalarial prophylaxis </p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>3.</b><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span><span dir="LTR">If <b>meningitis</b> is suspected (bulging fontanelle, stiff neck , vomiting ,vacant look), being treatment <b> immediately</b> unless the reference centers is nearby (less than 10 minutes journey ) and&nbsp; TRANSFER&nbsp; urgently.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 4.</b><span style="font-style:normal; font-variant:normal; font-size:7.0pt; font-family:Times New Roman; font-weight:700"> </span><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span><span dir="LTR">In cases of haemorrhagic fever , with cutaneous haemorrhagic lesions, hepatosplenomegaly , haematuria , TRANSFER <b> very URGENTLY</b>.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>5.</b><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span><span dir="LTR">If there is <b>diarrhoea</b> and/or <b> dehydration</b> , see <b><u>diarrhoea</u></b> and treat accordingly. Keep the child on the breast if he is being breast-fed; get him to drink small quantities of ORS solution , frequently (above all if he is vomiting).</span></p> <p class="MsoBodyText" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">Reintroduce normal feeding as soon as possible, so as to cover his increased fluid , caloric and protein requirements.</p> <p class="MsoBodyText" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> 6.<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">To exclude a <b>gastro-intestinal</b> or other <b>intra-abdominal infection</b> (peritonitis , appendicitis, shigellosis): palpate the abdomen. If there is guarding , tenderness or contraction: TRANSFER urgently.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> 7.<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">If there is a cough , see <b><u>cough and dyspnoea</u></b>, and treat accordingly.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> 8.<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">If there is ENT infection:</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <font color="#000080">&nbsp;a)<span style="font-style:normal; font-variant:normal; font-family:Times New Roman"> Pur</span></font></b><font color="#000080"><span dir="LTR"><b>ulent nasal discharge:</b></span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span></span><span dir="LTR">teach the mother to wipe the nose often and carefully;</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">if the fever persists into the 3 rd day;</span></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b>long-acting penicillin,</b> 50 000 units/kg/d IM, in 1 dose , for 5 days.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed">Inspect for progress on the 5 th day;</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> b)<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">examine the <b>external auditory meatus,</b> pulling the ear downwards and backwards;</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">if this is painful:</span></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b>anti-inflammatory</b>  medication by the mouth (e.g.paracetamol);</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">if there is suppuration:</span></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b>long-acting penicillin,</b> 50 000 units/kg/d IM in 1 dose for 5 days.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed">Inspect for progress on the 5th day;</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> c)<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">examine the <b>mouth</b> and <b>throat:</b></span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">sores or coated: <b>stomatitis;</b></span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">whitish coating on enlarged tonsils: <b> tonsilitis.</b></span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">painful tooth on percussion and swelling of the gum: <b>dental abscess:</b></span></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b>long-acting penciling ,</b> 50 000 units/kg/d lM in 1 dose , for 5 days.</p> <p class="MsoBodyTextIndent" dir="LTR">Inspect for progress on the 5th day.</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;"> </span></span><span dir="LTR">do not confuse an abscess or tonsilitis with mumps (epidemic parotiditis)-no treatment.</span></p> <p class="MsoBodyTextIndent" dir="LTR" style="text-indent: -18.0pt; margin-right: 18.0pt"> 9.<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span> <span dir="LTR">in the case of suspected urinary tract infection (pain on micturition and/or urinary abnormality)- see <b><u>urinary tract infection</u></b> and treat accordingly.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> 10.<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">Look for inflammation (pain , warmth , swelling) of the skin , eyes , muscles , joints , bones etc.-see <b> <u>dermatolog</u></b>y , <b><u>ophthalmology</u> </b>, <b><u> osteomyelitis</u></b> etc. and treat accordingly.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> 11.<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span dir="LTR">In the absence of specific signs:</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span></span><span dir="LTR">Look &nbsp;for evidence of contact with another child with a childhood illness;</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">check that the child has been vaccinated against measles;</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">look for early signs of a childhood illness (e.g. rash, eruption ,adenopathy etc.).</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> &nbsp;</p> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber4" bgcolor="#4E7864"> <tr> <td width="100%"> <b>&nbsp; <font color="#FFFFFF">4<span style="font-style:normal; font-variant:normal; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></font></b><font color="#FFFFFF"><span dir="LTR"><b>IF THERE IS NO IMPROVEMENT</b></span></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span></span><span dir="LTR">If the fever lasts more than 5 days and a repeat examination reveals nothing new,</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">Ii there is no cure on inspection of the 3 rd or 5th day as expected,</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">if there is recurrent fever without an established diagnosis,</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">REFER to exclude tuberculosis, typhoid or other causes.</span></font></p> <h3 dir="LTR" style="margin-left:0cm">&nbsp;&nbsp;&nbsp;&nbsp; </h3> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber5" bgcolor="#4E7864"> <tr> <td width="100%">&nbsp;<font color="#FFFFFF"><b>5</b><span style="font-style:normal; font-variant:normal; font-weight:700; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span dir="LTR">PREVENTION</span></b></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol"><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">Only give an antipyretic (aspirin) if the temperature exceeds 38C , especially at night before going to bed.</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol"><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">Be prepared to give <b>&nbsp;ant malaria chemoprophylaxis</b> in the young child or in a recent traveler:</span></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b>Chloroquine,</b> 10mg/kg once a week or 2 mg/kg/d , and treat any episode which&nbsp; may be malaria, which can happen in spite of preventive measures.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed">In addition , <b>chloroquine resistance</b> is possible in certain regions. In this case , it will be necessary to consider local therapeutic recommendations, e.g.:</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-left: 32.4pt; margin-right: 24.0pt; margin-top: 0cm; margin-bottom: .0001pt"> &nbsp;&nbsp; -<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp; </span> <span dir="LTR">combinations of <b>chloroquine</b> with <b> chlorhydrate</b> <b>of proguanil</b> , 5 mg/kg/d </span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 14.4pt"> or</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-left: 32.4pt; margin-right: 24.0pt; margin-top: 0cm; margin-bottom: .0001pt"> &nbsp;&nbsp; -<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span> <span dir="LTR">quinine , 10 mg/kg/d,</span></p> <p class="MsoNormal" dir="LTR" style="text-align: left; direction: ltr; unicode-bidi: embed; margin-right: 14.4pt"> e.g., in drops : R/quinine bichlorhydrate , 6 g; sodium bisulfite , 15 mg; aqua ad 30 ml, in a brown bottle; 0.05 ml/kg/day , or drop/kg/d, if 20 drops/ml.</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">Prevention against mosquito bites by the use of nontoxic repellents and impregnated mosquito nets.</span></p> <TR> <TD width="579"> <hr> <font color="#FF0000"><b>TROPICAL PAEDIATRICS </b></font>&nbsp;<font color="#800000" size="2"><b>(HANDBOOK)</b></font><hr> </TR></TBODY></TABLE></DIV> <DIV align=left> <TABLE height=67 cellSpacing=0 cellPadding=0 width=599 border=0> <TBODY> <TR> <TD width=579 height=65> <P class=MsoNormal dir=rtl style="MARGIN-BOTTOM: -15px; DIRECTION: rtl; unicode-bidi: embed; mso-pagination: none; mso-layout-grid-align: none" align=center><a href="index.htm">Home page</a>&nbsp; |&nbsp;<a href="eng-moarefi.htm">Introduction</a>&nbsp;|&nbsp;<a href="eng-tarh.htm"> Research Studies</a>&nbsp; |&nbsp;<a href="eng-talifat.htm"> Editorships</a>&nbsp; |&nbsp;<a href="eng-translate.htm"> Translations</a>&nbsp; |&nbsp;<a href="eng-kongereh.htm"> Conferences</a>&nbsp; </P> <P class=MsoNormal dir=rtl style="MARGIN-BOTTOM: -15px; DIRECTION: rtl; unicode-bidi: embed; mso-pagination: none; mso-layout-grid-align: none" align=center><a href="eng-tamas.htm">Contact Information</a>&nbsp; |&nbsp;<a href="eng-maghale.htm"> Articles</a>&nbsp; |&nbsp;<a href="news.htm"> Scientific meets &amp; events</a>&nbsp; |&nbsp;<a href="research.htm"> Research projects</a>&nbsp; |&nbsp; Theses</P></TD></TR></TBODY></TABLE></DIV></TD></TR></TBODY></TABLE></DIV></BODY></HTML>