ABSTRACT
Background: Dengue fever is an important tropical disease which is endemic in around 110 countries. It infects 50-100 million people worldwide per year. In India case fatality rate is 1-5% for severe Dengue. Between 2015-2017, 790 deaths have been recorded according to NVBDCP data. Global burden of Dengue has increased at least fourfold over last three decades and now 2.5 billion people at risk of disease. This study aims at determining sterile pyuria as a manifestation in patients presenting with Dengue fever, as patients may present with similar symptoms as that of urinary tract infection, thereby preventing unnecessary use of antibiotics.Methods: It is a Cross sectional observational study conducted on 100 consecutive patients with serologically proven Dengue fever. Patients satisfying inclusion and exclusion criteria underwent relevant investigations and in patients with urine routine showing pyuria, urine culture and sensitivity was done to rule out urinary tract infection and look for sterile pyuria.Results: Among 100 patients of dengue studied, age distribution being 18years to 70years, mean age was 33.27±13.2 years of them 78 were male and 22 were female. 41% patients showed pyuria in urine. 25 % patients were culture positive most common being E. coli and 16% patients had sterile pyuria.Conclusions: Sterile pyuria is not a well-recognized entity in Dengue fever and is often missed. This study shows that sterile pyuria is quite common manifestation in dengue fever which resembles urinary tract infection and therefore does not require any empirical antibiotic treatment.
ABSTRACT
Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are major healthcare problems affecting millions of people around the world each year and killing as many as one in four. The documented incidence of sepsis worldwide is 1.8 million each year with mortality rate of almost 30%. Sepsis is the 10th leading cause of death in the United States. Shock index (SI) is defined as “Heart rate divided by Systolic blood pressure (HR/SBP)”. Normal range is 0.5 to 0.7 in healthy adults.Methods: A Prospective study was conducted between August 2018 to March 2019 comprising of 100 consecutive patients presenting to emergency department and ICU with sepsis. Subjects were identified by having evidence of infection presenting with cardiovascular collapse or organ failure with help of q-SOFA(quick- sepsis related organ failure assessment ) and SOFA scores (sequential organ failure assessment score).Cases with clear alternative diagnosis were excluded. Vital signs were recorded, and Shock index was calculated. Primary outcome, which was use of Vasopressor therapy was analysed. Results : A Total of 100 cases were studied, of which 70 patients were males and 30 females with mean age of 48.5 ±16.2 yrs. Most of the cases were between 35 to 60 years. Patients were classified into 3 categories based on shock index:1. <0.8 (normal, n=16) 2. 0.8 to <1.2 (n=29) 3. >1.2 (n=55). The use of vasopressor therapy within first 24 hours for each group was 18%, 34%, and 78%. This difference was statistically significant (p=<0.05).Conclusion : In patients with sepsis an elevated shock index was indicator of early vasopressor therapy in the first 24hours. It is a simple bedside tool to identify septic patients in need for early vasopressor therapy thereby preventing further clinical deterioration.
ABSTRACT
Background: Dengue is an arthropod borne viral haemorrhagic fever. In India between 2015-2017, 790 deaths have been recorded according to NVBDCP data. Gastrointestinal manifestations are among the most common manifestations in dengue fever, and are most often missed due to lack of awareness. This study aims to find the spectrum of Gastrointestinal manifestations and correlation of GI manifestations with severity of Dengue.Methods: A cross-sectional observational study was conducted on 100 consecutive cases of serologically confirmed Dengue fever. Patients were examined clinically, and laboratory data was assessed till they got discharged. Gastrointestinal manifestations of dengue fever were noted and analyzed.Results: This study included 100 consecutive cases of dengue fever. Mean age of the study population was 32.48+12.40 years of them 77 were males and 23 were female patients. Gastrointestinal manifestations were noted in 96% of the patients. GI manifestations noted were Nausea in 71%, Elevation of transaminases in 59%, vomiting in 54%, pain abdomen in 31%, Ascites in 24% hepatomegaly in 14%, diarrhoea in 13%, Acalculous cholecystitis in 13%, Acute fulminant hepatitis in 6%, Upper GI bleed in 6%, splenomegaly in 5%, and Acute pancreatitis in 4% of patients. Of these, GI manifestations like nausea, vomiting, pain abdomen, GI bleed, ascites, jaundice, elevation of transaminases, acute fulminant hepatitis and acute pancreatitis correlated with severity of Dengue fever . Conclusion: Gastrointestinal manifestations in Dengue fever are much more common than once thought of. In our study it was found in 96 percent of patients making it most common manifestations in dengue fever. Transaminitis and Atypical GI manifestations like acute pancreatitis, acute fulminant hepatitis may indicate severe Dengue. The differential diagnosis of an acute febrile syndrome with abdominal pain or gastrointestinal symptoms in patients living in endemic areas should include Dengue fever.
ABSTRACT
Background: Malaria is fast emerging as a number one infectious disease with high morbidity and mortality across the globe. It’s being transmitted across 108 countries containing 3 billion populations (40% of world’s populations) with more than 3 million deaths per year. India is an endemic country for malaria with an estimated 70-100 million1 cases per year. 45-50% of them are due to Plasmodium falciparum (Pf). Pf is responsible for majority of severe and fatal malaria though death due to Plasmodium vivax mono infection have also been reported. Symptoms and sign are highly non-specific in malaria making it more of a clinical diagnosis more than a laboratory diagnosis. Presentation may vary at times and can be quite confusing as malaria is a multisystem disease. Authors’ idea was to study the variable manifestations in confirmed cases of malaria patients at our hospitalMethods: A hospital based cross sectional study was conducted for a period of one year-from 01-08-2015 to 31-07-2016 based on authors’ hospitals records (case sheets with demography profile, clinical features, investigations and treatment outcome).Results: A total of 369 patients positive for malaria parasite were included in the study. 369 were smear positive-219 positive for Plasmodium vivax, 127 were P. falciparum type and 23 were for both. Majority were males (64.50%) and belonged to the age group of 21-50 years (58.84%). They were admitted in post monsoon months (60.43%). Of them 46.44% had classical symptoms of malaria. All the patients had received mainly artemisinin combination therapy (ACT) and 91.87% patients recovered in 7-28 days. The mortality rate was nearly 5.69%.Conclusions: The present study was useful to know the varied manifestations of malaria and hence will be useful in making a clinical diagnosis of malaria.