Efficacy and Safety of Low Dose, Short Course Eltrombopag in Management of DF and DHF

Background: Dengue is the most widespread aedes mosquito borne viral disease which infects more than 50 million people every year. The clinical symptoms of dengue may vary from mild fever to life-threatening incidents. Eltrombopag, a non-peptide, oral TPO-R agonist, small molecular weight is quandaries with the transmembrane domain of a TPO receptor and persuades the Janus Kinase/Signal transducer and activator of transcription pathway, with a significant rise in platelet production.Material & Methods:This study was a cross-sectional observational study which was conducted at Tairunnesa Memorial Medical College and Hospital (TMMCH), Gazipur and Shin Shin Japan Hospital, Uttara, Dhaka. The study was conducted in between July 2021- December 2021. The sample size for this study was 100.Results:The mean age in group 1 was 25� in group 2 29�and in control group 29� The mean Baseline PLT * 109 /L for group 1 was 57�, for group 2, 51� and for control group 54�. Mean of systolic baseline BP (mmHg) for group 1 was 103.55� 5.04 for group 2 was 105.38�.34 and for control group was 101.97�28 and followed by the mean of diastolic baseline BP (mmHg) was 72.83�56, 72.84�.93 and 71.97�75. AEs was found in 4(12.1%) cases of group 1 where in group 2 it was 2(5.9%) and in control group was 3(9.1%). In day 7, the recovery rate of group 1 was 93.9% and in group 2 the recovery rate was 94.1%.Conclusions:Dengue is a vector-borne viral disease which needs medical assistance because it may lead to life-threatening outcome. Eltrombopag can be considered as a therapeutic option to increase the PLT counts in DF and DHF patients in the management of thrombocytopenia.

Dengue in India: An Overview

Background: Dengue fever has become a major public health concern in our country, causing significant morbidity and mortality. Because there is no definite drug or commercially available vaccine for dengue, prevention is the only option. As a result, early reporting of dengue cases is required in order to implement preventive measures before the disease spreads to epidemic proportions. Therefore, healthcare providers should notify every dengue incident to local authorities in the current format, including the District Health Officer or Chief Medical Officer of district concerned and the Municipal Health Officer of municipality concerned every week (daily during the transmission period). Materials and Methods: The data on dengue (2015-2021 till Oct.) was available at the National Vector Borne Disease Control Programme under the Ministry of Health & Family Welfare, Government of India, and has been used in this paper. Results and discussion: During the last two decades (2000-2009 and 2010-2019), significant geographical spread of the dengue has been experienced in India with the repeated outbreaks, and an 11 fold increase in number of cases. Despite an increase in the incidence of dengue fever, the case fatality rate in India has decreased from 3.3% in 1996 to 0.4% in 2010 to 0.1% in 2019. Early diagnosis and timely referral play a critical role in bringing down Case Fatality Rate (CFR). Conclusion: Dengue is a manifestation arising from the process of increasing vector density and adaptation to human habitation, as well as human lifestyle transformation, unplanned developmental activities exacerbated by climate change.

Gravidez heterotópica espontânea: implicações de um diagnóstico tardio / Spontaneous heterotopic pregnancy: implications of a late diagnosis

A gestação heterotópica é uma entidade rara, principalmente se resultante de concepção natural. O diagnóstico é ultrassonográfico, porém a gestação intrauterina concomitante contribui para a dificuldade propedêutica. Neste relato de caso, a detecção foi tardia, a ultrassonografia não identificou a gestação heterotópica e apenas durante a avaliação intraoperatória, por meio de uma cirurgia de emergência devido a choque hemorrágico, houve o reconhecimento. A suspeita de uma gestação heterotópica deve ser sempre aventada quando sinais clínicos típicos (sangramento, dor abdominal) estão presentes, mesmo na ausência de fatores de risco ou imagens anômalas na ecografia. Assim, uma intervenção precoce menos invasiva pode ser realizada, reduzindo a morbimortalidade materna e do feto intrauterino. Este relato de caso destaca uma situação incomum dentro dessa patologia rara: diagnóstico tardio, apenas no segundo trimestre de gestação, sem evidência prévia ultrassonográfica, certificada apenas durante o intraoperatório. O manejo cirúrgico preciso permitiu a manutenção da gravidez intrauterina.(AU)

Heterotopic pregnancy is a rare entity, especially if it is resulted from natural conception. The diagnosis is ultrasonographic, but the concomitant intrauterine pregnancy contributes to the propaedeutic difficulty. In this case report, the detection was late, the ultrasonography did not identify heterotopic pregnancy and, only during intraoperative evaluation through emergency surgery, exploratory laparotomy, there was recognition. The suspicion of a heterotopic pregnancy should always be raised when typical clinical signs (bleeding, abdominal pain) are present, even in absentia of risk factors or anomalous images on ultrasound. Thus, a less invasive early intervention can be performed, reducing maternal and intrauterine fetus morbimortality. This case report highlights an unusual situation within this rare pathology: late diagnosis, only in the second trimester of pregnancy, without previous ultrasound evidence, certified only during the intraoperative period. Precise surgical management allowed the maintenance of intrauterine pregnancy.(AU)

Diffuse alveolar hemorrhage complicating dengue haemorrhagic fever in a 15-year-old boy: A case report

Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.

Whether Platelet Count Really Influences the Outcome of Dengue Patients? A Study Done at Tertiary Care Centre in North Karnataka Region

In many parts of India, Dengue has become a major public health problem and Kalaburagi District in North Karnataka region was previously not known to be an endemic area for dengue. Three clinical syndromes, classic dengue fever, dengue haemorrhagic fever and dengue shock syndrome are seen with dengue virus infection. This present study was undertaken to find out whether platelet count really influences the outcome of dengue patients in a tertiary health care centre in Kalaburagi, Karnataka.METHODSAbout hundred patients admitted in our hospital with positive Dengue NS1 and Dengue IgM were selected. The follow up of patients is done from the onset of fever to up to twelve days or until their recovery according to discharge criteria of WHO whichever of them is earlier.RESULTSIn this study, 100 cases were studied, out of which Dengue fever was seen in 73 cases, Dengue Hemorrhagic Fever in 17 cases and Dengue Shock Syndrome in 10 cases was seen based on WHO criteria. In this study, 99 percent patients had fever. In this study 73 percent of patients were Dengue NS1 Positive and 27 percent of patients were Dengue IgM Positive. In present study, continuously increasing pattern of platelet count was seen in 55 percent cases; initial fall then rise of platelet count was seen in 38 percent cases and persistently low pattern of platelet count was seen in 7 percent cases. This study showed that 30 percent of patients had bleeding manifestations and bleeding manifestations were maximum in patients having low platelet counts. In the present study, 92% cases improved and 8% cases expired.CONCLUSIONSAmong the three clinical syndromes, Dengue fever was more common than dengue haemorrhagic fever and dengue shock syndrome. It was found that platelet count influenced the outcome of dengue patients. Management of dengue case is mainly supportive

Synovial cell sarcoma of the pleura: an uncommon cause of a haemorrhagic pleural effusion

Soft tissue tumors account for a small percentage of malignancies and synovial sarcomas account for 10% of soft tissue tumors in our body, among them are the synovial sarcomas (SS).These arise from various sites and are of mesenchymal origin, Primary pleural synovial sarcomas are very rare tumours and account for not more than 0.5% of lung malignancies, they are being diagnosed mainly by the immunohistochemistry and classical cytogentic translocation t(x;18). This tumor has no sex preference and is commonly seen in the age group of 30-45.Our case is of a elderly male with massive pleural effusion who was diagnosed as having biphasic variant of synovial sarcoma of pleura by the help of immunohistochemistry. Treatment is mainly surgical resection and chemotherapy with ifosfamide/ adriamycin or radiotherapy. It must be considered as differential for biopsy proven malignant mesothelioma and hence immunohistochemistry should be must for all biopsy proven mesotheliomas.

Clinical and laboratory profile of children with dengue fever admitted at a tertiary care hospital in Mangalore, Karnataka, India: a retrospective study

Background: Dengue fever caused by dengue virus is a self-limiting acute febrile illness transmitted by Aedes aegypti, a daytime biting mosquito. Dengue virus belongs to family of Flaviviridae and there are 4 serotypes. A fifth serotype DENV-5 was isolated in 2013 which was said to cause mild form of the disease. In 2019 total numbers of dengue cases are 10,524 in Karnataka which is 138% increase over 2018 (4,427 cases).Methods: A retrospective conducted in Yenepoya Medical College hospital from January 2017 to July 2019 for a period of 2' years. Medical records of children who were diagnosed with dengue fever were retrieved and analyzed. Clinical and laboratory findings were noted down. Clinical course and outcome were noted down from the case sheet and cases were classified as per WHO 2011 classification.Results: 97 children diagnosed with dengue fever were included in the study. Common age group was 5-15 years. 49.5% had dengue fever, 40.2% had dengue haemorrhagic fever (DHF) and 10.3% had expanded dengue syndrome. Fever was the main complaint. Children with dengue fever presented with vomiting, abdominal pain, myalgia, arthralgia in descending order of frequency. Children with DHF, petechiae were seen in 38% patients. Among bleeding manifestations, epistaxis was more common. Children with expanded dengue syndrome had atypical manifestations.Conclusions: Dengue fever like any other viral illness, presents with prodromal symptoms which should be picked up at the earliest with high index of suspicion in children coming from endemic area. Identification of atypical manifestations and co-infections at the earliest and prompt treatment avoids serious life-threatening complications.

High Sensitivity C- Reactive Protein Level in Acute Cerebrovascular Accident (Stroke) at a Tertiary Care Centre.

Stroke is the leading cause of death worldwide and one of the main causes of long term disability. According to WHO, 15 million suffer from stroke each year. Studies have shown that levels of hsCRP measured shortly after stroke predicted complimentary aspects of prognosis. There is possibility that elevated hsCRP levels has direct relation to extent of cerebral tissue injury. We wanted to measure the levels of hsCRP in acute cerebrovascular accident. To correlate the level of hsCRP with severity of stroke and outcome.METHODSStudy was conducted in patients admitted in medical ward and medical ICU in tertiary care hospital (Grant Government Medical College and Sir JJ Group of Hospitals). It was a cross sectional study. A total of 150 patients who presented with stroke and fulfilled inclusion and exclusion criteria were enrolled in the study. In all patients hsCRP levels were measured within 48 hours of admission. Data was collected prospectively in a Microsoft Excel database. Statistical analysis was done using non-parametric ANOVA (Kruskal Wallis test) and Mann Whitney test.RESULTSMean age of patients was 59 ± 12 years. hsCRP levels were raised in stroke patients. Also values were found to be more in haemorrhagic stroke (value) than in ischemic stroke (value) and the difference was found to be significant. Significant correlation was also found between hsCRP levels and GCS with lower GCS scores associated with higher hsCRP levels in both types of stroke. Mean hsCRP level in survivors was 21.83 ± 23.17 mg/L and in non survivors was 82.07 ± 25.83 mg/L and the difference was statistically significant (p <0.0001)CONCLUSIONSWe concluded that hsCRP level is increased in cases of stroke (both ischemic and haemorrhagic) suggesting an inflammatory response in acute stroke. Increased levels of hsCRP correlated with severity of neurological deficit and worse outcome.

A study on awareness and prevention of dengue fever among outpatients attending a health centre in the rural area of Kancheepuram district

Background: Dengue fever has become one of the major public health problems in all developing countries. It is essential to create awareness among people as it can be prevented by simple practices. The study was conducted to find the awareness among the people thus determining the need to educate the people regarding the preventive measures of dengue fever.Methods: This was a cross-sectional community-based study conducted among the outpatients and their attenders visiting a Rural Health Training Center of private Medical College and Hospital, belonging to Alandur block in Kancheepuram district, Tamil Nadu during January 2019 to March 2019. 260 subjects within the age group of 18 to 82 years were selected by convenient sampling method. The data was collected by interviewing and by using questionnaires. Analysis of the structured data was done using SPSS software version 16.Results: The study included 260 respondents who gave their consent for the study. 60.8% of the study group were males. Mean age of the study group was 35.36 years. 58.1% of the individuals were educated more that 10th standard. Knowledge about the mode of transmission was correctly stated by 85.8%. Around 15% were not aware of breeding places of mosquitoes.Conclusions: From this study it was evident that there is a definite gap in understanding the various aspects of dengue fever. Thus, we conclude that regular awareness programs should be conducted in the form of campaigns and house visits to create awareness among all individuals.

Is the clinicopathological profile of dengue syndrome changing?: a 6 year study of different epidemics at a tertiary care center in India

Background: As an arthropod-borne viral disease, dengue epidemics has created much public health hazards in tropical countries. In the national capital of India, there has been more than six epidemics. Dengue remains a notifiable disease in India. It is important that we understand the changing clinicopathological profile of this viral infection to prepare ourselves better for any impending future epidemic. This study done at a tertiary care center looks into the recent epidemics to understand the changing trends in the disease profile in two phases of three years each. Further, authors also assessed the utility of the tourniquet test in dengue syndrome.Methods: 260 serologically confirmed patients were recruited in two phases of the study. We evaluated them for clinical, epidemiological and pathological profile of dengue and trends in haematological, biochemical and radiological parameters during the course of the disease and its correlation with the severity of the disease.Results: Fever, headache, body ache, pharyngeal and conjunctival congestion, rhinitis, rash and diarrhea incidences were similar in both epidemics. Lymphadenopathy was seen in 18(18%) patients compared to 40(25%) in the second epidemic. More number of hemorrhagic manifestations with GI and retinal bleed was seen compared to earlier epidemics, which had higher liver involvement.Conclusions: Although the presentation of the disease has not shown a drastic change over the last decades, the severity varies depending on the predominant serotype. Patients with evidence of serositis, increased activated lymphocytes has a longer course in disease with poorer outcome. Early rising haematocrit, ALT/AST ratio, LDH and deranged coagulation parameters are important tools in triaging patients for priority of urgent care and hospitalization in a scenario of a future outbreak.

Comparative lipid profile study between ischemic and haemorrhagic stroke

Background: Stroke is one of the major global health problems. Stroke is the most common clinical manifestation of cerebrovascular disease of which more than 99% are due to arterial involvement and less than 1% due to venous involvement in the form of Cerebral Venous Thrombosis (CVT). Among arterial causes 85% are due to infarction and 15% due to haemorrhage.1,2 There is  difference in serum lipid levels in subtypes of strokes to guide lipid-lowering therapy which can reduce incidence of stroke and stroke related mortality by adapting primary and secondary preventive measures.3,4  Authors have endeavoured to correlate severity of lipid derangement and stroke.Methods: In this study 64 consecutive eligible ischaemic stroke cases and 64 eligible hemorrhagic stroke cases would be included. Cases of strokes will be divided into ischaemic and hemorrhagic as per clinical features and with help of brain imaging by CT scan and MRI at the time of admission and 8 hour fasting lipid profile was collected from all cases. All this information will be filled in preformed format.Results: Serum lipid profile of two categories of stroke showed raised serum total cholesterol in 39.1% patients of ischaemic stroke in contrast to 18.8% patients with haemorrhagic stroke (p=0.019).Stroke patients showed raised in LDL cholesterol in 29.7% patients of ischaemic stroke in contrast to 9.4% patients with haemorrhagic stroke, (p=0.007).Conclusions: Based on the finding of our study we conclude that ischemic stroke patient had higher lipid derangement as compare to haemorrhagic stroke in terms of raise total cholesterol, LDL cholesterol and decrease HDL cholesterol.

Generation and evaluation of a recombinant myxomavirus expressing the VP60 protein of rabbit haemorrhagic disease virus / 生物工程学报

Rabbit haemorrhagic disease virus (RHDV) and myxoma virus (MYXV), are two pathogens that have harmful effect on rabbit breeding and population decline of European rabbits in their native range, causing rabbit haemorrhagic disease (rabbit fever) and myxomatosis, respectively. The capsid protein VP60 of the RHDV represents the major antigenic protein. To develop a recombinant bivalent vaccine candidate that can simultaneously prevent these two diseases, we used the nonessential gene TK (thymidine kinase) of MYXV as the insertion site to construct a recombinant shuttle vector p7.5-VP60-GFP expressing the RHDV major capsid protein (VP60) and the selectable marker GFP. Then the shuttle vector p7.5-VP60-GFP was transfected into rabbit kidney cell line RK13 which was previously infected with MYXV. After homologous recombination, the recombinant virus expressing GFP was screened under a fluorescence microscope and named as rMV-VP60-GFP. Finally, the specific gene-knock in and expression verification of the vp60 and gfp genes of the recombinant virus was confirmed by PCR and Western blotting. The results showed that these two genes were readily knocked into the MYXV genome and also successfully expressed, indicating that the recombinant MYXV expressing the vp60 of RHDV was generated. Protection against MYXV challenge showed that the recombinant virus induced detectable antibodies against MYXV which would shed light on development of the effective vaccine.

Crimean-congo haemorrhagic fever: a global perspective

Crimean-Congo Haemorrhagic Fever (CCHF) is caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae, causing severe and often fatal haemorrhagic fever in humans. CCHF is pervasive, now found in Europe, Asia, Africa, the Middle East and the Indian subcontinent. CCHF spreads to humans either by tick bites or by contact with blood and tissues from infected animals or humans. CCHF outbreaks constitute a threat to public health services because of its epidemic potential, its high case fatality ratio (10-40%), and its potential for nosocomial outbreaks and its quandaries in treatment and prevention. It is characterized by sudden onset with initial sign symptoms including fever, chills, agitations, myalgia, headaches, vomiting, abdominal pain, arthralgia, ecchymosis, melena, haematuria, nose bleeding, vaginal bleeding, bradycardia, thrombocytopenia. It is diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay, ELISA test, antigen detection tests. Overall supportive therapy is the mainstay of patient management in CCHF. Seriously ill patients require intensive care. Ribavirin for the treatment of CCHF cases it is most effective, if administered very soon after the onset of clinical signs (e.g., during the first 48 hours). Prevention should be taken which reduce risk of tick to human transmission and human to human transmission.

Occurrence of Intestinal and Caecal Coccidiosis in Rajasri Birds

Coccidiosis in poultry is still considered as one of the main diseases affecting performance of poultry reared under intensive production systems. Coccidiosis was diagnosed in Rajasri birds upon routine postmortem examination conducted at Department of Veterinary Pathology, College of Veterinary Science, Hyderabad. PM examination of 423 birds conducted during a period of one month, out of which 136 birds were diagnosed with intestinal coccidiosis (32.15%) and 120 birds with caecal coccidiosis (28.36%). Clinically birds showed weakness, somnolence, ruffled feathers, pale comb, mucoid bloody diarrhea and death. Coccidiosis was initially diagnosed on the basis of faecal smear examination and histopathological alterations in intestines. Gross examination of birds showed pale muscle, dehydrated and emaciated carcass. Extremely ballooned intestine and caeca and haemorrhages in intestinal mucosa were seen. Upon opening of the small intestines and caeca, watery ingesta mixed with mucus and blood was observed. Faecal smears made from duodenum, jejunum, ileum and caecum revealed coccidial oocysts. Histopathological examination of intestine and caecum revealed coccidia lifecycle stages with destruction of different layers of the intestine and caecum with infiltration of heterophils and mononuclear cells (MNC)

Outbreak investigation and control measures following dengue fever cases in Vadodara, July-August 2017

Background: Dengue fever is one of the major public health problems among all the vector born diseases. It is an emerging disease of tropical and sub-tropical regions, affecting urban, peri-urban and rural areas. Twenty five cases of dengue fever were reported in our hospital and other private hospitals from Undera village, which is in the peri urban area of Vadodara, so an investigation was carried out. The objective of this study is to find out the incidence and demographic details of people affected by fever during the outbreak and to find the environmental factors responsible for the outbreak.Methods: Community based, cross-sectional, direct interviewing of community members of Undera village in Vadodara district was carried out on 21st August 2017 and 23rd August 2017.Results: In this outbreak investigation, 219 fever cases were reported from 2930 population residing in 645 houses. There were 25 confirmed cases of dengue fever, out of which three deaths were reported. This included one pregnant woman during this outbreak. Seventy percent of fever cases were in the age group 0-30 years. Daily wagers were affected more than other occupations. At least one fever case was reported from 109 houses. Breeding places for mosquitoes were observed surrounding the houses from were fever cases reported.Conclusions: The dengue fever outbreak was confirmed through laboratory as well as clinico-epidemiological correlation with confirmed clinical picture and presence of breading places of Aedes mosquitoes. The fatality rate was 12% and there were three complicated deaths.

Assay of Proinflannatory Cytokines (IL-6, IFN γ, TNFα) and its Correlation with Disease Severity in Dengue Fever

Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6,IFgamma and TNF alpha) in patients with dengue infection andto determine the correlation of level of cytokine with diseaseseverity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IF gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.

Assay of Proinflannatory Cytokines (IL-6, IFN γ, TNFα) and its Correlation with Disease Severity in Dengue Fever

Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6, IFNgamma and TNF alpha) in patients with dengue infectionand to determine the correlation of level of cytokine withdisease severity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IFN gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.

Clinical and laboratory profile of dengue fever: a retrospective study

Background: The global incidence of dengue has grown dramatically in recent decade. Half of world’s population is now at risk. India represents significantly a larger burden, accounting for nearly 34% of the global burden of dengue infection. Dengue infection needs to be addressed as a single disease with different clinical presentations ranging from asymptomatic conditions to severe clinical courses that may lead to high morbidity and mortality.Method: This was retrospective observational study carried out during period of July 2017 to April 2018, to study clinical profile and laboratory parameters in dengue fever patients. Confirmed dengue cases having NS1 positive or IgM positive or having both NS1 and IgM positive or dengue ELISA reactive, having minimum one CBC reports done and not having other confounding factor such as co-infection, bone marrow diseases etc. that may altered clinical and laboratory results are included in study. Statistical analysis was done by SPSS software version 18.0.Results: Out of 48 confirmed dengue cases maximum patients 58.33% was from young age group (21 to 40 years) with M:F ratio was 2.43:1. Fever was found in 100% patients, in order of frequency followed by headache, bodyache, abdominal pain, weakness, retro-orbital pain, anorexia, dry cough, back pain, nausea, diarrhoea, vomiting, rash, joint pain, itching and malena.NS1was positive in 41.67% cases, dengue ELISA in 31.25%, IgM was positive in 20.83% cases, and both NS1 and IgM positive were in 4.17% cases. TLC count was low 35.42%, high in 12.50% of cases and remaining had normal TLC count. Platelet count was ranged between normal platelet counts to thrombocytopenia. One case had platelet count less than 20000. Out of 48 patients, 2 (4.17%) had malena.Conclusion: In this study, fever was found in all patients, and headache, body ache and weakness were common symptoms, but significant number of patients also had gastroentstinal and respiratory symptoms like abdominal pain, nausea, diarrhea, vomiting and dry cough. TLC count ranging from normal TLC, leukopenia to leucocytosis. Large number of patients had low platelet count that shows dengue fever had varied clinical presentation.

A study on the outbreak of dengue fever in a tertiary care children's hospital in southern Tamil Nadu, India

Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study's objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.

Effect of co morbidities on the clinical outcome of Dengue fever

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world. A number of Dengue Haemorrhagic Fever (DHF) risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF/ Dengue shock syndrome (DSS).Methods: A hospital based prospective case control study was done by taking 40 cases each of dengue fever with diabetes mellitus, hypertension, diabetes and hypertension and 30 cases of dengue with asthma/COPD and these patients were compared with controls of 100 patients with dengue fever but no comorbidities. All patients had Dengue serology NS1 or IgM positive.Results: Patients admitted with dengue fever with comorbidities had increased duration of hospitalization with P value of 0.012. The clinical outcome of the 250 patients. In the subgroup of dengue fever patients with DM and Dengue fever with DM and HTN, they were noted to have a 2.69 and 3.06 times increased risk effect of DHF.Conclusions: Dengue fever with DM or DM with HTN have a higher risk of developing DHF when compared with patients with dengue fever with no comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring.