JINNAH SINDH MEDICAL UNIVERSITY

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1 MODULE TITLE INTRODUCTION RATIONALE TARGET STUDENTS DURATION Spiral II Infectious Diseases Pakistan is facing a double burden of disease (BoD), with endemicity of hepatitis B and C with 7.6% affected individuals; the 5th highest tuberculosis burden in the world, and focal geographical area of malaria endemicity. The overall HIV prevalence of 21.0%, although 77.0% of those who inject drugs are using sterile injecting equipment. In addition, the country has high rates of unscreened blood transfusions. Drug-resistant tuberculosis is estimated at 4.3% among new cases and 19.0% among previously treated cases. Vaccine preventable diseases and new emerging infections call for strengthening disease surveillance and response system. High government commitment and partners engagement resulted in a dramatic drop in the number of polio cases to only 08 cases reported from 7 districts in 2017, as compared to 20 cases from 14 districts in the preceding year. In young children, diarrhoea and respiratory illness remain as the major killers. Considering the prevalence of infections in Pakistan, it becomes imperative that infectious diseases get a special slot in the curriculum. It is kept strategically at the start of 3rd year MBBS so that students are able to understand key issues early in the clinical years. This module is intended to help students become aware of the etiology, risk factors and preventive measures related to infections. Also, it is aimed that the learners ability to deal with patients in the wards will improve once their core knowledge is sound. 3 rd Year MBBS, semester V 5 weeks 1

2 By the end of the five-week module, students will be able to: MODULE OUTCOMES relate the etiology and pathogenesis of common adult and paediatric infectious conditions with their clinical manifestations and principles of management (including therapeutics) relate diagnosis of infectious conditions with the burden of disease within and outside Pakistan describe legal issues and general toxicology in Forensic Medicine & Toxicology DEPARTMENTS OBJECTIVES COMMUNITY MEDICINE Community Medicine, Forensic Medicine & Toxicology, Paediatrics, Pathology, Pharmacology, Internal Medicine By the end of the module, students will be able to: Introduction & Definition of communicable and infectious diseases. Define the following terms: infection, infestation, infection agent, control, elimination and eradication, agent, host and environment Discuss the role of incubation period, serial time period in control of infection Describe the epidemiologic triangle Control of infection and communicable diseases. Differentiate between infectious and communicable diseases Differentiate between the disinfection and sterilization Describe control measures for infectious & communicable diseases Explain the role of immunprophylaxis& screening in the control of infection Measles And its prevention. Describe the etiology, epidemiology,control and prevention of measles 2

3 Describe the clinical features, assessment and diagnosis of measles Discuss the role of immunization in prevention of measles Pertussis and its prevention Describe the etiology, epidemiology,control and prevention of Pertussis Describe the clinical features, assessment and diagnostic criteria of Pertussis Discuss the process of control and prevention of Pertussis Scabies and its prevention Describe the etiology, epidemiology,control and prevention of Scabies Describe the clinical features, assessment and diagnostic criteria of Scabies Discuss the process of control and prevention of Scabies Acute Diarrheal disease and its prevention. Describe the etiology, epidemiology,control and prevention of Acute Diarrheal diseases Describe the clinical features, assessment and diagnostic criteria of Acute Diarrheal diseases Discuss the process of control and prevention of Acute Diarrheal diseases Cholera and its prevention Describe the etiology, epidemiology, risk factors, control and prevention of Cholera Describe the clinical features &diagnostic criteria of Cholera Discuss the process of control and prevention of Cholera Worm infestations and their prevention 3

4 Describe the epidemiology, risk factors, control and prevention of worm infestations Describe the clinical features &diagnostic criteria of worm infestations Discuss the process of control and prevention of worm infestations Zoonotic diseases and their prevention List Different Zoonotic diseases Describe the etiology, epidemiology, risk factors, control and prevention of Zoonotic diseases Describe the clinical features & diagnostic criteria of worm infestations Discuss the process of control and prevention of worm infestations Leishmaniasis and its prevention. Describe the etiology, epidemiology, risk factors, control and prevention of Leishmaniasis Describe the clinical features & diagnostic criteria of Leishmaniasis Discuss the process of control and prevention of Leishmaniasis Emerging and re-emerging diseases and their prevention. List different emerging diseases Describe the etiology, epidemiology, risk factors, control and prevention of Emerging And re-emerging disease FORENSIC MEDICINE& TOXICOLOGY Introductory class Define Forensic Medicine and Toxicology and its various branches Discuss the importance and utility of Forensic Medicine and Toxicology and its various branches, its role in crime detection and other medical, legal and ethical issues in civilized society. 4

5 Describe the basics of Legal system in Pakistan Discuss the types of Courts in Pakistan and their powers Legal Procedures - I Define important legal terms such as Summons, warrant, perjury, deposition, exhibit, offence, cognizable offence, non cognizable offence, oath, conduct money, summons case, warrant case, bail, FIR, Describe Medical evidence, types of evidence (oral, documentary, hearsay, circumstantial) Discuss the Documents prepared by a medical man(post mortem Reports, Medico Legal Reports, Certificates such as birth certificates, death certificates, sickness certificates, certificates of unsoundness of mind) Differentiate between dying declaration and dying deposition Legal Procedures II Define the types of witnesses, types of examination in the court Discuss the recording of evidence and procedure of court attendance with special emphasis on the guidelines for doctor in the witness box Describe Professional secrecy and Privileged communication Legal Procedures III Describe the Criminal Justice system in Pakistan, Describe Pakistan Penal Code, Criminal Procedure Code and its execution and delivery List the general presumptions and exemptions of law General Toxicology Describe Toxicology 5

6 Classify poisons according to chief symptoms Discuss the medico legal classification and International toxicity rating of poisons NOTE: Rest of General Toxicology will be taught in tutorials Laws in relation to medical man I Discuss medical ethics and its significance Describe Hippocratic Oath and principles of Bioethics Discuss the duties of doctor as advised by international code of medical ethics Describe the composition, functions of Pakistan Medical & Dental Council at present and its role in medical education Laws in relation to medical man II By the end of the lecture the candidate should be able to discuss: Privileges & obligations of registered medical practitioners Professional misconduct (Infamous conduct) and consent Types of consent and the role of consent in Medical Examination Criteria for giving valid consent Doctrine of informed consent (Rule of full disclosure) Certain legal deviations/exemptions of consent Laws in relation to medical man-iii By the end of the lecture the candidate should be able to describe: Professional negligence Types of negligence Res- Ipsa- Loquotar Novus ActusInterveniens 6

7 Vicarious Liability Laws relation to medical men IV List 5 D S for plaintiff s success Define Euthanasia and its types Discuss Compensation For Medical Negligence Describe the defenses for defendant doctor and defenses for reducing damages Describe Transplantation of Human Organs and Tissues Act 2010 Discuss Ethical issues related to euthanasia General Toxicology I: By the end of the tutorial the candidate should be able to: Define poison. Differentiate between poison and medicine Describe the routes of administration and excretion of poisons List the Factors modifying action of poisons. FORENSIC MEDICINE DEMONSTRATIONS General Toxicology II: By the end of the tutorial the candidate should be able to discuss the methods of diagnosing poisoning in living & dead General Toxicology III: By the end of the tutorial the candidate should be able to discuss: The duties of a doctor in a case of suspected poisoning General principles of treatment of poisoning 7

8 Gastric lavage Antidote therapy General Toxicology IV: By the end of the tutorial the candidate should be able to describe the role of Poisoning Information Centre in treatment of cases of poisoning Pyrexia of Unknown Origin (PUO) Define Pyrexia of Unknown Origin Discuss the criteria of PUO List the investigations related to PUO Develop an outline of management plan for PUO INTERNAL MEDICINE Malaria Define Malaria Classify its type Discuss the clinical features & complications of Malaria List the investigations related to malaria Develop an outline of management plan for malaria Enteric fever Define Enteric fever Discuss the clinical features & complications of Enteric fever List the investigations related to Enteric fever Develop an outline of management plan for Enteric fever Viral hemorrhagic fever Define Dengue, Lasa and Congo fever Discuss the clinical features & complications of Dengue, Lasa and Congo fever List the investigations related to Dengue, Lasa and Congo fever 8

9 Develop an outline of management plan for Dengue, Lasa and Congo fever Human Immunodeficiency Virus (HIV) Define Human Immunodeficiency Virus (HIV) Discuss the clinical features & complications of HIV List the investigations related to HIV Develop an outline of management plan for HIV Acute Diarrhea Define Diarrhea Classify its type List the investigations related to Diarrhea Discuss the complications of Diarrhea Develop an outline of management plan for Diarrhea according to IMNCI Fungal Infections Define clinically important fungal infections Classify its type Discuss its syndromes Discuss the clinical features of fungal infections List the investigations related fungal infections and their complications Develop an outline of management plan for these conditions Nematodes Define nematodes Classify Nematodes Discuss the clinical features & complications of nematodes List the investigations related nematodes Develop an outline of management plan 9

10 Trematodes Define Trematodes Classify Trematodes Discuss the clinical features & complications due to Trematodes List the investigations related Trematodes Develop an outline of management plan Cestodes Define Cestodes Classify Cestodes Discuss the clinical features & complications of Trematodes List the investigations related Trematodes Develop an outline of management plan Viral infections Define mumps, measles, cytomegalo virus, infectious mononucleosis Classify these conditions Discuss the clinical features & complications of Mumps, Measles, Cytomegalo Virus (CMV), Infectious Mononucleosis List the investigations related mumps, measles, CMV & Infectious Mononucleosis Develop an outline of management plan for these conditions 10

11 Overview of infectious diseases Classify bacterial, viral, fungal and parasitic diseases Describe clinical significance of infectious diseases with respect to organ systems Acute and chronic inflammation Discuss pathogenesis of acute and chronic inflammation Sepsis/ SIRS Describe inflammation leading to Sepsis and SIRS Typhoid fever Discuss microbiology of typhoid and paratyphoid fever and its burden in endemic countries Gram negative infections PATHOLOGY & MICROBIOLOGY Describe the importance of gonococcal infections and its pathogenesis Summarise main features of Pertussis and Pseudomonas infections Gram positive infections (3) Describe Skin and soft tissue infection ( boils, furuncles, folliculitis) with causative organisms Describe Importance of blood culture and its significance in diagnosis of infectious diseases (endocarditis, typhoid) Describe the process of performing and interpret Stool urine detailed report, Culture, PCR, Serology. Mycobacterial infections Explain the pathogenesis of leprosy. Briefly discuss Tuberculous and Non-Tuberculous Mycobacterial infection Anaerobic infections Describe Clostridial infections caused by C. Perfringes, Difficile, Botulinum, Tetani. Discuss the Pathogenesis of Tetanus 11

12 Viral infections Discuss common organisms in relation to fever with rash and their pathogenesis Discuss measles, rubella, varicella, mumps. Parasitic infections (9) Classify viral haemorrhagic fevers. Describe the Importance of dengue fever and VHF Summarise main features of rabies virus Discuss the Pathogenesis of Rabies and its clinical features Summarise main features of herpes family of viruses Describe Latent viral infections (hsv1-6, VZV, CMV,EBV) Describe Retrovirus in relation to HIV and its pathogenesis to cause AIDS Discuss various tests for diagnosis and screening of HIV, Western blot, immunofloresence, ELISA Describe worm infestations by Trematode, Nematodes, and Cestodes Discuss malarial parasite and its pathogenesis Discuss Bacterial and parasitic causes of diarrhea and dysentery. Summarise main features of bacterial agents salmonella, shigella, vibrio, campylobacter. Summarise main features of diarrhea and dysentery causing ova and parasites (entamoeba, ascaris, pinworm) Summarise main features of microorganisms causing STD ( Chlamydia, Neisseria, Chancre, Condyloma, Syphilis, Trichomonas ) Fungal infections Classify fungi into yeast and mold. Describe various fungal infections causing Thrush, Ringworm, Aspergillosis and Mucormycosis Vaccine preventable infectious diseases 12

13 Discuss vaccine preventable infections Enumerate vaccines included in EPI (BCG, OPV/IPV, DPT, MMR, Hep B, Hib, ) Introduction to Chemotherapeutic Drugs Explain the general principles of antimicrobial therapy and their classes and mechanism(s) of action. Discuss antimicrobial spectra of different drug classes, incidence of drug resistance and its mechanisms and clinical uses. Cell-wall Synthesis Inhibitors-I Classify Penicillins Describe the basic and clinical pharmacology of Penicillins Explain Pharmacokinetics and dynamics of Penicillins PHARMACOLOGY Cell-wall synthesis Inhibitors-II Describe basic and clinical pharmacology of Cephalosporins and other drugs. Enumerate classes and their drugs Explain kinetics and dynamics of Cephalosporins and other drugs Protein Synthesis Inhibitors-I Classify Protein synthesis inhibitors Describe the basic and clinical pharmacology of Tetracyclines & Aminoglycosides Explain Pharmacokinetics and dynamics of Tetracyclines & Aminoglycosides Protein Synthesis Inhibitors-II 13

14 Classify Macrolides Describe the basic and clinical pharmacology of Macrolides Explain Pharmacokinetics and dynamics of Macrolides & others Anti-metabolites drugs-i Classify Sulfonamides and Trimethoprim Explain their Pharmacokinetics, dynamics and their clinical uses Anti-metabolites drugs-ii Classify the Fluoroquinolones. Explain their Pharmacokinetics, dynamics and their clinical uses Anti-Protozoal drugs Classify Anti-protozoal drugs & anti- malarial drugs, Describe their Pharmacokinetics and dynamics. Treatment of infectious Diarrhea &Amoebiasis Explain various Antibiotics used in diarrhea and their Pharmacokinetics and dynamics. Classify Anti-Amoebic drugs Describe their Pharmacokinetics and dynamics Treatment of Typhoid Fever Enumerate the drugs used in the treatment of Typhoid fever Describe their Pharmacokinetics and dynamics Anti-Viral Drugs Classify various drugs used in the treatment of various viral infections Explain their pharmacokinetics and dynamics Anti-Helminthic Drugs Classify various drugs used in the treatment of Helminthic infections Explain their pharmacokinetics and dynamics 14

15 Integrated Management of Neonatal and Childhood Illnesses (IMNCI) Explain the role & goals of IMNCI Describe the components&structure of IMNCI. Describe the case management strategy of IMNCI. Diarrhoea. Describe the Diarrhoea and dehydration. Differentiate between acute and chronic diarrhoea Enumerate the risk factors & causes for acute diarrhoea Assess degree of dehydration in the patient Explain the management protocol for diarrhoea Describe the treatment plan for various degrees of dehydration Describe Dysentery in children Explain the management protocol for dysentery PEDIATRICS Respiratory Tract Infections (RTI) in children Describe the clinical features of RTIin children. Classify RTIs according to the symptoms as per IMNCI classification. Diagnose pneumonia on the basis of clinical features Diagnose sore throat in children on the basis of data provided Explain the management protocol for sore throat & cough in children Vaccinations Describe the EPI schedule. List the dose, route and site of EPI vaccines. Explain the protocol for management of side effects of vaccination. Formulate the vaccination schedule for different age groups Differentiate among various types of rashes in children Diagnose Measles based on clinical features. Explain the management protocol for measles with complications List additional vaccines. SKILLS LAB General Physical Examination 15

16 Internal Assessment: Continuous monitoring of attendance and practical assessment in short groups. It will be in the form of MCQs, assignments, stages/sub-stages, projects, quiz or OSPE. Internal evaluation carries 20% weightage in summative semester examination. Semester Examination MCQs and OSPE (observed + un observed). 16