Establishment of SMS Dengue Severity Score

Background: Dengue infection is a disease that progresses rapidly to life-threatening conditions. Our goal was to develop a practical scoring system based on clinical profiles and routine tests to predict the severity of infection. Methods: This cross-sectional observational study included 500 patients with dengue infection. Patient demographics, clinical symptoms, regular laboratory tests, and results were collected. Dengue infections are divided into three classes, depending on their severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Based on the total score, patients were divided into three severities. Results: Patients with DSS and DHF scored higher with worsening clinical features and routine laboratory tests compared to DF. Clinical predictors of severity include older age, increased white blood cell (WBC) count, increased hematocrit, increased prothrombin time, decreased platelet count, decreased blood pressure, presence of peri-gallbladder (GB) edema, third space loss, hepatomegaly, and other organ involvement. The severity range is 0–12, and the score is 0–3 for DF, 4–8 for DHF, and 9–12 for DSS. Based on the derived scores, patients were classified according to their original severity in 63% of cases. Conclusion: This dengue infection severity scores correctly classified patients according to their original severity grade of DF, DHF, or DSS. This scoring system helps to quickly assess dengue infections and start treatment according to the correct severity category.

Clinico-immunological aspects of vernal catarrh in hilly terrains of Himachal Pradesh.

Very few immunological studies in vernal catarrh have been conducted in India and abroad, but none in Himachal Pradesh in spite of its high incidence in the State. In the present study 25 patients of vernal catarrh residing at a height ranging between 1000 to 2500 meters above mean sea level have been evaluated. Their immunological status of serum and tears after detailed clinical assessment was studied by single radial immunodiffusion technique of Mancini et al. The values of serum IgA and IgM were significantly higher in patients than in controls. The serum IgE level had no significant difference. The IgG was significantly lower in patients with vernal catarrh. The values of tear IgM, IgE and IgA in these patients were significantly higher than in controls. However, in no case or control group C3C and C4 were detected in tears. The limbal type of vernal catarrh was found to be the most common in this part of the country. No mixed case was seen. Derangement of the immune system in the pathogenesis of vernal catarrh is suggested.

Renal angioplasty in a case of renovascular hypertension presenting with stroke.

A young female patient with renovascular hypertension due to fibromuscular dysplasia of the right renal artery presenting with stroke is described. The patient was treated by renal angioplasty.

Unusual presentation of aneurysm of aorta.

An unusual case of a saccular aneurysm of arch of aorta, masquerading as pulmonary artery branch stenosis, proved by cardiac catheterisation and angio cardiography is presented.

Estimation of pulmonary artery pressure by colour guided continuous wave Doppler in cases of ventricular septal defect and tricuspid regurgitation.

The accuracy of a non-invasive estimation of systolic pulmonary artery pressure in 33 patients with ventricular septal defect and/or tricuspid regurgitation, by colour guided continuous wave Doppler was evaluated. The estimated pulmonary artery pressure correlated well with values obtained at cardiac catheterization (r = 0.93). Correlation was better in cases with ventricular septal defect (r = 0.98) than in cases with tricuspid regurgitation (r = 0.87). Pulmonary artery pressure was under-estimated in cases with mild tricuspid regurgitation, probably due to eccentricity of regurgitant jet in some of these cases.

Role of intrathecal tetanus antitoxin (equine) in tetanus neonatorum.

The present study includes 50 cases of tetanus neonatorum who were given 200 IU of tetanus antitoxin (equine) intrathecally once only and 500 IU intravenously daily for 3 consecutive days. Nutrition was provided with intravenous drip containing dextrose and other electrolytes. The overall mortality was 78%. It appears that the course of the disease remains unaltered with intrathecal tetanus antitoxin in tetanus neonatorum.