Study of Hepatic Involvement and Thrombocytopenia in Dengue.

OBJECTIVE: The purpose of this study was to assess the pattern of hepatic involvement and thrombocytopenia in patients with dengue fever and time taken for clinical/biochemical recovery. METHODS: This is a retrospective study done in a tertiary centre. A total of 1111 patients with documented dengue fever, either with NS1 antigen/IgM antibody positive report who were admitted between January 2016 to December 2016.The aminotransferase levels and platelet counts were measured on day 1,4 and7. Patients were assessed clinically on day 1,4,7 or till discharge/death accordingly. CONCLUSION: Out of 1111 patients with dengue infection, 993 had either thrombocytopenia or hepatic involvement or both. Majority of patients with thrombocytopenia and hepatic dysfunction recovered between 4-7 days of admission i.e 53.98% and 29.20%. Statistically significant corelation of platelet count and aminotransferase levels with recovery or death of the patient was seen in our study.

Urinary Tract Infection in Elderly: Clinical Profile and Outcome.

OBJECTIVE: Urinary tract infection (UTI) being the most common bacterial infection with considerable morbidity and mortality especially in hospitalized geriatric patients, this study was designed to assess clinical profile, predisposing factors, uropathogen profile causing UTI and to identify associated factors responsible for mortality. METHODS: :Prospective observational study was undertaken among elderly patients aged ≥ 60 years in a tertiary care hospital. 95 indoor patients from medicine wards having symptoms of UTI and urine culture showing significant growth were included in the study. Demographic profile, clinical features, predisposing factors, laboratory features, urine culture reports, antimicrobial susceptibility patterns and outcome were noted and analysed. RESULTS: Of the 95 patients studied, 55.78% were males. 50.52% patients were in age group of 61 to 70 year. Frequency of micturition was the major symptom. Diabetes mellitus was the most common predisposing factor associated with UTI seen in (46.31%) patients. Gram negative organism accounted for 88(92.63%) of bacterial isolates, with Escherichia coli seen in 47.36% of cases. Non-E.coli gram negative organisms such as Pseudomonas, Klebsiella showed lower sensitivity to Levofloxacin, Piperacillin + Tazobactam, Amikacin and Ceftazidime. Mortality rate was 17.89%. Significantly higher mortality was seen in patients with diabetes mellitus (p< 0.0001), complicated UTI (p<0.001), dementia (p<0.0001), serum creatinine >1.4 mg/dl ((p<0.0001) and increasing number of predisposing factors. Fatality was not associated with use of urethral catheters and increased leucocyte count. CONCLUSION: Diabetes mellitus, dementia increases risk of mortality in elderly UTI patients. As gram negative isolates shows drug resistance, prompt diagnosis and the right choice of antimicrobials can play a key role in reducing mortality in elderly UTI patients.

Dyskeratosis congenita with portal hypertension of unknown etiology.

Dyskeratosis Congenita (DKC) is a rare progressive bone marrow disorder associated with multi-systemic involvement. It is also characterized by triad of abnormal skin pigmentation, nail dystrophy and mucosal leukoplakia. Liver cirrhosis and portal hypertension are said to be uncommon among these patients. We hereby report a case of an adult male who presented with pancytopenia, abnormal skin pigmentation, nail dystrophy and mucosal leukoplakia. Skin biopsies along with clinical features confirmed the case. Imaging studies were reported as suggestive of and portal hypertension. Liver biopsy done but non-conclusive. Patient's one son and one daughter also had similar skin pigmentation.