ABSTRACT
INTRODUCTION: With expanding clinical spectrum of dengue fever, encephalitis has been documented with increasing frequency. The aim of this study was to investigate the incidence, predictors and prognostic factors of dengue encephalitis (DE) in the setting of dengue viruses (DENV) infection. MATERIALS AND METHODS: A hospital-based prospective cohort study was carried out, which included laboratory confirmed dengue positive cases. All dengue cases were categorized into nonencephalitis or encephalitis group. We estimated DE incidence and analyzed clinical, laboratory and neuroimaging data on admission, discharge and follow-up for 3 months to assess its predictors and prognostic factors. RESULTS: Out of the enrolled 540 confirmed dengue cases, 27 patients had DE, representing 5% incidence. Two third of the DE patients were 20 years of age or younger, with male preponderance (81.5%). Fever, headache, and altered sensorium were present in >90% on admission. Significant predictors of encephalitis were mean body temperature during fever (P < 0.001), headache (P = 0.015), secondary dengue (P = 0.005), dengue hemorrhagic fever (P < 0.001), elevated hematocrit (P < 0.001), liver function test derangement (P < 0.05), and low platelet count (P = 0.006). Poor outcome factors for DE patients were prolonged duration of fever (P < 0.001), seizure (P = 0.002), and cerebrospinal fluid (CSF) DENV positivity (P = 0.049). One third patients died and the remainder of them recovered. An increasingly higher incidence rate with high mortality of DE is reported. CONCLUSION: Clinical and laboratory parameter along with DENV positivity in CSF can predict and prognosticate dengue encephalitis.
ABSTRACT
BACKGROUND: Novel influenza A (H1N1) virus emerged in April, 2009, spread rapidly to become pandemic by June, 2009. OBJECTIVE: To study the clinco-epidemiological profile of pH1N1and seasonal influenza (SI) from 2009 to 2013. MATERIALS AND METHODS: Retrospective, hospital-based study was done by reviewing medical records for collecting demographic and clinical profile of the study samples. RESULT: Out of 969 samples, positivity and case fatality for pH1N1 and SI was 9.39 and 20.87% vs 11.76 and 7.89%, respectively. Among pH1N1and SI, sex distribution, mean age, and age group involved were 54.95% females, 37.10 years, and 20-29 years (23.08%) vs 43.86% females, 40.32 years, and 20-29 years (22.81%), respectively. Mortality shift was observed from younger to older and healthier, 75% to comorbid, 100% from 2009-2010 to 2012-13 for pH1N1. CONCLUSION: We observed seasonal variation, cocirculation, similar clinical features, decreased virulence, and community spread with respect to pH1N1 and SI from 2009-2013.
ABSTRACT
Thyroid-associated orbitopathy (TAO) is a self-limiting auto-immune condition usually associated with Grave's disease. It is characterised by ocular pain, eyelid swelling, chemosis, proptosis and keratopathy. As the mechanism for ophthamoplegia and optic neuropathy is the orbital swelling leading to mechanical restriction of ocular muscles and compression of optic nerve, one expects proptosis rather than ptosis in TAO. We describe a case of a young adult woman who presented with acute onset restriction of movement along with partial ptosis and severe diminution of vision in left eye. The MRI of orbit revealed significant swelling of recti along with signal alteration consistent with TAO. The radio-isotope thyroid scan revealed thyroiditis, and thyroid peroxidase (TPO) antibody was significantly high; hence, the diagnosis of Hashimoto thyroiditis was considered. A course of intravenous methylprednisolone followed by oral steroid was administered, which produced marked improvement in vision and extraocular movement.
