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Background: Dengue fever and scrub typhus are considered an endemic disease in the Indian subcontinent. The epidemiology and clinical presentations are complex and vary each year.? Objective: The objective of this study was to estimate the prevalence of coinfection with scrub typhus in children diagnosed with dengue fever. Methods: A retrospective hospital-based, cross-sectional study was done in the Department of Pediatrics of a teaching hospital in Puducherry. All children (0–14 years) who had enzyme?linked immunosorbent assay (ELISA) reported scrub typhus among those diagnosed with dengue fever (NS1Ag or immunoglobulin M ELISA positivity) during 2012–2016. Medical records with incomplete data were excluded from the study. Odds ratio was calculated to find out the association of coinfections. An independent t-test was used to find out the statistical significance. P < 0.05 was considered statistically significant. Results: Atypical features of dengue were present in 250/318 (78.6%) children. Coinfections were seen in 62/318 (19.4%) children. Scrub typhus was the most common (n = 51/62, 82.2%). The chance of scrub typhus in a dengue serology?positive child is significant when the symptoms are atypical or protracted (OR– 2.6, P = 0.033). Conclusion: High index of suspicion should be present in endemic dengue and scrub typhus coinfection.
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Objective To explore the attempted suicide risk factors of socio-demographic and clinical charac-teristics in major depressive disorder patients with atypical features (e.g. increased appetite, weight gain and greater time spent sleeping). Methods This was a secondary analysis of the data from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and carried out in 13 major mental health centers in China. Totally 179 patients were diagnosed as atypical major depres-sive disorder patients in all 1172 major depressive disorder patients using Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-Ⅳ) by psychiatrists. Suicide attempters and nonattempters were grouped base on the interview results of suicidality module of the Mini International Neuro-psychiatric Interview (MINI). Multiple logistic regression were used to assess association between independent variables and attempted suicide in major depressive disorder patients with atypical features. Results The rater of attempted snicide was 23.5% (42/179) of atypical major depressive disorder patients reported prior or current attempted suicide. Compared to nonattempters, attempters had higher levels of suicidal ideation, postpartum depressive episodes, and the use of antipsychotic, mood stabilizers and benzodiazepines (P<0.05). Logistic regression analysis showed that number of admissions (OR=1.73, 95% CI: 1.093~2.740) and depressive episodes with suicidal ideation (OR=3.90, 95%CI: 1.506~10.092) were significantly associat-ed with attempted suicide in atypical unipolar depression patients (P<0.05). Conclusions High number of admissions and high levels of suicidal ideation may be considered as potential risk factors to identify atypical unipolar depression patients at risk for future suicidal behavior.
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Adult onset Still's disease is a rare but potentially serious disease. We present five cases of adult-onset Still's disease seen by us over a period of one year. The patients were all females and 28-39 years of age. Symptoms had been present for 2-6 weeks in three patients. The other two had been on a few years' follow-up for rheumatoid arthritis before the onset of rashes and fever. The patients had persistent erythematous maculopapular eruptions on face, body and extremities, with moderate to severe pruritus and/or a burning sensation that decreased their quality of life. The typical evanescent rash was not observed. High ferritin values were detected in all the patients and total serum IgE was increased in two. All the patients were started on oral prednisolone (0.5-1.0 mg/kg/day), and methotrexate (10-15 mg/week) had to be added in three patients. One patient was started on tocilizumab due to recalcitrant disease and one was lost to follow-up. Further investigation and classification of the various atypical cutaneous findings in adult-onset Still's disease is necessary.
Subject(s)
Adult , Edema/pathology , Erythema/pathology , Exanthema/pathology , Female , Humans , Skin/pathology , Still's Disease, Adult-Onset/pathologyABSTRACT
Anorexia nervosa is the disorder characterized by marked weight loss, food refusal, and amenorrhea. It is common disorder among young women in Western societies and is believed to be relatively rare outside Western culture. The author report two cases of female adolescents who presented with atypical features, i.e., the patients acknowledged their thinness and did not demonstrate fear of obesity. Reports from several Oriental countries support the notion that these atypical features are not uncommon among Eastern subjects.
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Most intracranial meningiomas present on the C-T as typical features with homogeneous, occasionally lobulated mass of density equal or greater than of surrounding brain tissue. After contrast injection, there is uniform and homogeneous enhancement in the density. Infrequently a significant number present as atypical features which are regional inhomogenecity of tumor mass on C-T and common source of error in the diagnosis of meningioma. The authors reviewed 25 consecutive meningiomas, all confirmed pathologically. 7 cases have been encountered as atypical features on the C-T. Among them, 2 cases of peritumoral low density were diagnosed as meningioma with C-T only. 5 cases(2 cases of peritumoral cyst, 2 cases of intratumoral cyst, 1 case of peritumoral bleeding) were misdiagnosed initially as malignant lesion based on C-T findings. Those C-T patterns have been found to correlate with certain histologic and morphologic alternation in tumor anatomy. Close correlation with pathological findings of tumor necrosis, cystic changes and hemorrhage was noted.