Spontaneous widespread muscle hematoma complicated by pyomyositis in a case of dengue hemorrhagic fever: a case report from Nepal.

Introduction and importance: Most dengue infections are asymptomatic, and some of them develop haemorrhagic manifestations with or without shock. However, dengue can sometimes present with very rare complications like pyomyositis. Case presentation: A healthy 27-year-old male, presented with a 2-day fever, confirmed to be dengue through a positive non-structural protein 1 test. Despite initial symptomatic management, his condition worsened and he was hospitalized. Leucocyte and platelet counts dropped to the lowest value on the seventh day of illness, followed by the gradual development of chest pain, persistent fever, and severe limb pain. Radiographic evaluation revealed pleural effusion, and multiple intramuscular haematomas complicated by pyomyositis. Pleural effusion resolved on its own. Pyomyositis resolved with 6 weeks of appropriate antibiotics and aspiration of pus. Clinical discussion: Dengue infection, caused by a dengue virus transmitted through Aedes mosquitoes, is a significant public health concern in many parts of the world. Dengue haemorrhagic fever is a severe form of dengue infection characterized by vascular leakage, thrombocytopenia, and bleeding manifestations. Although musculoskeletal manifestations are common in dengue fever, the occurrence of multiple muscle haematomas and pyomyositis as complications of Dengue haemorrhagic fever is rare. Drainage or aspiration of pus combined with the antibiotics according to the pus culture and sensitivity report is the management strategy. Conclusion: Prolonged fever with severe musculoskeletal pain and focal tenderness on examination in a dengue patient, warrant radiographic testing (ultrasonography or MRI) considering the differentials of haematoma, myositis, or pyomyositis.

Race/ethnic comparisons of waist-to-height ratio for cardiometabolic screening: The study of women's health across the nation.

OBJECTIVE: To compare the performance of waist-to-height ratio as a screening tool for cardiometabolic conditions - hypertension, prediabetes/diabetes, dyslipidemia, and subclinical inflammation - in 5 race/ethnic groups of mid-life women. METHODS: Waist-to-height ratio and 4 cardiometabolic conditions were assessed in 3033 premenopausal midlife women (249 Hispanic, 226 Chinese, 262 Japanese, 1435 European-American, and 861 African American). The areas under the receiver operating characteristic curve (AUROC) were compared across the five race/ethnic groups using waist-to-height ratio to determine the likelihood of the four cardiometabolic conditions. RESULTS: The performance of waist-to-height ratio to detect one or more cardiometabolic conditions was comparable among all race/ethnic groups (AUROC > 0.60, p = 0.252), and was good/fair (AUROC > 0.60) when hypertension, prediabetes/diabetes, dyslipidemia, or subclinical inflammation were analyzed separately. The performance of waist-to-height ratio of 0.50 was skewed towards higher specificity among groups with low prevalence of cardiometabolic conditions and lower median waist-to-height ratio, and towards higher sensitivity among groups with high prevalence of cardiometabolic conditions and higher median waist-to-height ratio. CONCLUSIONS: Waist-to-height ratio can be used for community-based screening of mid-life women who may need secondary prevention for cardiometabolic conditions. A simple public health message: "Keep your waist to less than half of your height" applies to midlife women.