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JINNAH SINDH MEDICAL UNIVERSITY
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Spiral II, 2019-2020 MODULE TITLE Infectious Diseases
INTRODUCTION
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 majorkillers.
RATIONALE
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.
TARGET STUDENTS 3rd Year MBBS, DURATION 06 weeks
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MODULE OUTCOMES
By the end of the six-week module, all the students of 3rd year MBBS will be able to:
relate the etiology and pathogenesis of common adult andpaediatric
infectious conditions with their clinical manifestations and principles of
management (includingtherapeutics)
relate diagnosis of infectious conditions with the burden of diseasewithin
and outside Pakistan
describe legal issues and general toxicology in Forensic Medicine &
Toxicology
DEPARTMENTS
Community Medicine
Forensic Medicine& Toxicology
Peadiatrics
Pathology
Pharmacology
Internal Medicine
OBJECTIVES By the end of the module, all the 3rd year MBBS students will be able to:
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COMMUNITY MEDICINE
Introduction & Definition of communicable and infectious diseases. • Define the following terms: infection, infestation, infection agent, control,
elimination and eradication, agent, host andenvironment • Discuss the role of incubation period, serial time period in control ofinfection • Describe the epidemiologictriangle
Control of infection and communicable diseases.
• Differentiate between infectious and communicablediseases • Differentiate between the disinfection andsterilization • Describe control measures for infectious & communicablediseases • Explain the role of immunprophylaxis& screening in the control ofinfection
Measles And its prevention. • Describe the etiology, epidemiology,control and prevention ofmeasles • Describe the clinical features, assessment and diagnosis ofmeasles • Discuss the role of immunization in prevention ofmeasles
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Pertussis and its prevention • Describe the etiology, epidemiology,control and prevention ofPertussis • Describe the clinical features, assessment and diagnostic criteria ofPertussis • Discuss the process of control and prevention ofPertussis
Scabies and its prevention
• Describe the etiology, epidemiology,control and prevention ofScabies • Describe the clinical features, assessment and diagnostic criteria ofScabies • Discuss the process of control and prevention ofScabies
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 Diarrhealdiseases
Cholera and its prevention • Describe the etiology, epidemiology, risk factors, control and prevention ofCholera • Describe the clinical features &diagnostic criteria ofCholera • Discuss the process of control and prevention ofCholera
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Worm infestations and their prevention • Describe the epidemiology, risk factors, control and prevention of worminfestations • Describe the clinical features &diagnostic criteria of worminfestations • Discuss the process of control and prevention of worminfestations
Zoonotic diseases and their prevention • List Different Zoonoticdiseases • Describe the etiology, epidemiology, risk factors, control and prevention of Zoonotic
diseases • Describe the clinical features & diagnostic criteria of worminfestations • Discuss the process of control and prevention of worminfestations
Leishmaniasis and its prevention. • Describe the etiology, epidemiology, risk factors, control and prevention of
Leishmaniasis • Describe the clinical features & diagnostic criteria ofLeishmaniasis • Discuss the process of control and prevention ofLeishmaniasis
Emerging and re-emerging diseases and their prevention.
• List different emergingdiseases • Describe the etiology, epidemiology, risk factors, control and preventionof
Emerging And re-emergingdisease
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FORENSIC MEDICINE&
TOXICOLOGY
Introductory class
Define Forensic Medicine and Toxicology and its variousbranches
Discuss the importance and utility of Forensic Medicine and Toxicology andits
various branches, its role in crime detection and other medical, legal and
ethical issues in civilizedsociety.
Describe the basics of Legal system inPakistan
Discuss the types of Courts in Pakistan and theirpowers
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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, deathcertificates,
sickness certificates, certificates of unsoundness ofmind)
Differentiate between dying declaration and dyingdeposition
Legal Procedures – II
Define the types of witnesses, types of examination in thecourt
Discuss the recording of evidence and procedure of court attendance with
special emphasis on the guidelines for doctor in the witnessbox
Describe Professional secrecy and Privilegedcommunication
Legal Procedures – III
Describe the Criminal Justice system inPakistan,
Describe Pakistan Penal Code, Criminal Procedure Code and its executionand
delivery
List the general presumptions and exemptions oflaw
General Toxicology
DescribeToxicology
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Classify poisons according to chiefsymptoms
Discuss the medico legal classification and International toxicity rating ofpoisons
NOTE: Rest of General Toxicology will be taught in tutorials
Laws in relation to medical man – I
Discuss medical ethics and itssignificance
Describe Hippocratic Oath and principles ofBioethics
Discuss the duties of doctor as advised by international code of medicalethics
Describe the composition, functions of Pakistan Medical & Dental Councilat
present and its role in medicaleducation
Laws in relation to medical man – II
By the end of the lecture the candidate should be able to discuss:
Privileges & obligations of registered medicalpractitioners
Professional misconduct (Infamous conduct) andconsent
Types of consent and the role of consent in MedicalExamination
Criteria for giving validconsent
Doctrine of informed consent (Rule of fulldisclosure)
Certain legal deviations/exemptions ofconsent
Laws in relation to medical man-III
By the end of the lecture the candidate should be able to describe:
Professionalnegligence
Types ofnegligence
Res- Ipsa-Loquotar
NovusActusInterveniens
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VicariousLiability
Laws relation to medical men – IV
List 5 D’S for plaintiff’ssuccess
Define Euthanasia and itstypes
Discuss Compensation For Medical Negligence
Describe the defenses for defendant doctor and defenses for reducing
damages
Describe Transplantation of Human Organs and Tissues Act2010
Discuss Ethical issues related toeuthanasia
FORENSIC MEDICINE
DEMONSTRATIONS
General Toxicology I:
By the end of the tutorial the candidate should be able to:
Definepoison.
Differentiate between poison andmedicine
Describe the routes of administration and excretion ofpoisons
List the Factors modifying action ofpoisons.
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 suspectedpoisoning
General principles of treatment ofpoisoning
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Gastric lavage
Antidotetherapy
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
INTERNAL MEDICINE
Pyrexia of Unknown Origin (PUO)
Define Pyrexia of UnknownOrigin
Discuss the criteria ofPUO
List the investigations related toPUO
Develop an outline of management plan forPUO
Malaria
DefineMalaria
Classify itstype
Discuss the clinical features & complications of Malaria
List the investigations related to malaria
Develop an outline of management plan formalaria
Enteric fever
• Define Enteric fever
• Discuss the clinical features & complications of Entericfever
• List the investigations related to Enteric fever
• Develop an outline of management plan for Entericfever
Viral hemorrhagic fever
• Define Dengue, Lasa and Congofever
• Discuss the clinical features & complications of Dengue, Lasa and Congofever
• List the investigations related to Dengue, Lasa and Congofever
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• Develop an outline of management plan for Dengue, Lasa and Congofever
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 forHIV
Acute Diarrhea
• DefineDiarrhea
• Classify its type
• List the investigations related toDiarrhea
• Discuss the complications ofDiarrhea
• Develop an outline of management plan for Diarrhea according toIMNCI
Fungal Infections
Define clinically important fungalinfections
Classify its type
Discuss itssyndromes
Discuss the clinical features of fungalinfections
List the investigations related fungal infections and theircomplications
Develop an outline of management plan for theseconditions
Nematodes
• Definenematodes
• ClassifyNematodes
• Discuss the clinical features & complications ofnematodes
• List the investigations related nematodes
• Develop an outline of managementplan
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Trematodes
• DefineTrematodes
• ClassifyTrematodes
• Discuss the clinical features & complications due toTrematodes
• List the investigations related Trematodes
• Develop an outline of managementplan
Cestodes
• DefineCestodes
• ClassifyCestodes
• Discuss the clinical features & complications ofTrematodes
• List the investigations related Trematodes
• Develop an outline of managementplan
Viral infections
• Define mumps, measles, cytomegalo virus, infectiousmononucleosis
• Classify theseconditions
• Discuss the clinical features & complications of Mumps, Measles, Cytomegalo
Virus (CMV), InfectiousMononucleosis
• List the investigations related mumps, measles, CMV & InfectiousMononucleosis
• Develop an outline of management plan for theseconditions
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PATHOLOGY &
MICROBIOLOGY
Overview of infectious diseases
Classify bacterial, viral, fungal and parasiticdiseases
Describe clinical significance of infectious diseases with respect to organsystems
Acute and chronic inflammation
Discuss pathogenesis of acute and chronicinflammation
Sepsis/ SIRS
Describe inflammation leading to Sepsis and SIRS Typhoid fever
Discuss microbiology of typhoid and paratyphoid fever and its burdenin
endemiccountries Gram negative infections
Describe the importance of gonococcal infections and itspathogenesis
Summarise main features of Pertussis and Pseudomonasinfections
Gram positive infections (3)
Describe Skin and soft tissue infection ( boils, furuncles, folliculitis) withcausative
organisms
Describe Importance of blood culture and its significance in diagnosisof
infectious diseases (endocarditis, typhoid)
Describe the process of performing and interpret Stool urine detailed report,
Culture, PCR,Serology.
Mycobacterial infections
Explain the pathogenesis ofleprosy.
Briefly discuss Tuberculous and Non-Tuberculous Mycobacterialinfection Anaerobic infections
Describe Clostridial infections caused by C. Perfringes, Difficile, Botulinum,Tetani.
Discuss the Pathogenesis ofTetanus
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Viralinfections
Discuss common organisms in relation to fever with rash and theirpathogenesis
Discuss measles, rubella, varicella,mumps.
Parasitic infections (9)
Classify viral haemorrhagicfevers.
Describe the Importance of dengue fever andVHF
Summarise main features of rabiesvirus
Discuss the Pathogenesis of Rabies and its clinicalfeatures
Summarise main features of herpes family ofviruses
Describe Latent viral infections (hsv1-6, VZV,CMV,EBV)
Describe Retrovirus in relation to HIV and its pathogenesis to causeAIDS
Discuss various tests for diagnosis and screening of HIV, Westernblot,
immunofloresence,ELISA
Describe worm infestations by Trematode, Nematodes, andCestodes
Discuss malarial parasite and itspathogenesis
Discuss Bacterial and parasitic causes of diarrhea anddysentery.
Summarise main features of bacterial agents salmonella, shigella, vibrio,
campylobacter.
Summarise main features of diarrhea and dysentery causing ova andparasites
(entamoeba, ascaris,pinworm)
Summarise main features of microorganisms causing STD ( Chlamydia,Neisseria,
Chancre, Condyloma, Syphilis, Trichomonas)
Fungal infections
Classify fungi into yeast andmold.
Describe various fungal infections causing Thrush, Ringworm, Aspergillosisand
Mucormycosis
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Vaccine preventable infectious diseases
Discuss vaccine preventableinfections
Enumerate vaccines included in EPI (BCG, OPV/IPV, DPT, MMR, Hep B, Hib,)
PHARMACOLOGY
Introduction to Chemotherapeutic Drugs
Explain the general principles of antimicrobial therapy and their classes and
mechanism(s) ofaction.
Discuss antimicrobial spectra of different drug classes, incidence ofdrug
resistance and its mechanisms and clinicaluses. Cell-wall Synthesis Inhibitors-I
ClassifyPenicillins
Describe the basic and clinical pharmacology ofPenicillins
Explain Pharmacokinetics and dynamics ofPenicillins
Cell-wall synthesis Inhibitors-II
Describe basic and clinical pharmacology of Cephalosporins and otherdrugs.
Enumerate classes and theirdrugs
Explain kinetics and dynamics of Cephalosporins and otherdrugs
Protein Synthesis Inhibitors-I
Classify Protein synthesisinhibitors
Describe the basic and clinical pharmacology of Tetracyclines &Aminoglycosides
Explain Pharmacokinetics and dynamics of Tetracyclines &Aminoglycosides
Protein Synthesis Inhibitors-II
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ClassifyMacrolides
Describe the basic and clinical pharmacology of Macrolides
Explain Pharmacokinetics and dynamics of Macrolides &others
Anti-metabolites drugs-I
Classify the Fluoroquinolones.
Explain their Pharmacokinetics, dynamics and their clinical uses
Anti-metabolites drugs-II
Classify Sulfonamides and Trimethoprim
Explain their Pharmacokinetics, dynamics and their clinicaluses
Anti-Protozoal drugs
Classify Anti-protozoal drugs & anti- malarialdrugs,
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 Typhoidfever
Describe their Pharmacokinetics and dynamics
Anti-Viral Drugs
Classify various drugs used in the treatment of various viral infections
Explain their pharmacokinetics and dynamics
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Anti-Helminthic Drugs
Classify various drugs used in the treatment of Helminthic infections
Explain their pharmacokinetics and dynamics
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PEDIATRICS
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.
Diarrhea. 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
Respiratory Tract Infections (RTI) in children
Describe the clinical features of RTI in 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.
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Internal Assessment:
Internal assessment will be conducted as per institutional policy. It carries 20%
weightage in final examination.
Annual Examination MCQs and OSPE (observed + Un observed).