Clinical profile of Thrombocytopenia in Acute Febrile Illnesses; a hospital-based study.

Background Thrombocytopenia is a common haematological abnormality noted in clinical practice, however, it can be missed in cases where specific investigations are not asked for. Acute Febrile Illness with thrombocytopenia is a diagnostic and therapeutic challenge, as thrombocytopenia has an inverse relation to mortality and morbidity in various febrile illnesses. Vector-borne and zoonotic diseases (like malaria, dengue, scrub typhus, and leptospirosis), infections and sepsis are some of the common causes of fever with thrombocytopenia. Objective To identify the causes of fever with thrombocytopenia, assess the clinical complications associated with febrile thrombocytopenia, and overall study the clinical profile of thrombocytopenia in a tertiary care hospital Method Medical records of all adult patients, admitted to a tertiary level hospital, with fever and thrombocytopenia (platelet count < 1,00,000 /mm3 ) were assessed (from October 2009 to March 2011). Detailed case history, general physical examination findings, routine and specific examinations were recorded according to a pre-decided format. Data were analysed using SPSS 16.0 Result Acute febrile illness with thrombocytopenia was most commonly seen in Dengue patients. Headache and arthralgia were more commonly encountered in scrub typhus. Platelet transfusions were necessitated in a large number of patients, especially in scrub typhus. Malaria patients had the highest mortality rate. Conclusion Acute Febrile Illnesses (AFI) are of varied origins, and proper diagnosis is imperative. The degree of thrombocytopenia in infections has a prognostic value. It can also help in differential diagnosis and clear identification of aetiology of acute febrile illnesses. Timely identification and management of thrombocytopenia in acute febrile illness can positively impact the overall patient outcome.

Redefining the Criteria for Grading Varicoceles Based on Reflux Times: A Clinicoradiological Correlation.

The aims of the study were to redefine the criteria used to grade varicoceles, based on reflux times that correlate with Dubin and Amelar clinical grading by overcoming the limitations of clinical grading and to include the less known entity of intratesticular varicoceles in the grading. Prospective correlative study was undertaken at JSS Hospital, Mysore, India during the period from July 2010 to October 2014. All patients with clinical suspicion of varicocele were clinically graded by Dubin and Amelar grading system and were later subjected to duplex ultrasound examination. The duration of the reflux obtained during the Valsalva maneuver was measured in milliseconds. Patients with intratesticular varicocele were noted and they were subgraded. One hundred patients were examined as per the methodology.The mean reflux times obtained as per the clinically graded varicoceles were as follows: subclinical varicocele, 835 ms; grade 1 varicocele, 1907 ms; grade 2 varicocele, 3108 ms; and grade 3 varicocele, 4508 ms.Based on the results obtained, we propose a modified radiological grading of the varicocele that is based on reflux times at Valsalva maneuver for each clinical grade. The presence of an intratesticular varicocele with any of the above grades is to be suffixed with "I."

Common and Uncommon Presentation of Fluid within the Scrotal Spaces.

Ultrasonography(US) of the scrotum has been demonstrated to be useful in the diagnosis of fluid in the scrotal sac. Grayscale US characterizes the lesions as testicular or extratesticular and, with color Doppler, power Doppler and pulse Doppler, any perfusion can also be assessed. Cystic or encapsulated fluid collections are relatively common benign lesions that usually present as palpable testicular lumps. Most cysts arise in the epidydimis, but all anatomical structures of the scrotum can be the site of their origin. US may suggest a specific diagnosis for a wide variety of intrascrotal cystic and fluid lesions and appropriately guide therapeutic options. The paper reviews the current knowledge of ultrasound in conditions with fluid in the testis and scrotum. The review presents the applications of ultrasonography in the diagnosis of hydrocele, testicular cysts, epididymal cysts, spermatoceles, tubular ectasia, hernia and hematoceles. The aim of this paper is to provide a pictorial review of the common and uncommon presentation of fluid within the scrotal spaces.

Duodenal leiomyoma--a rare cause of haematemesis.

Leiomyoma of the duodenum is a rare tumour. Small intestinal tumours contributing to upper gastrointestinal bleed is still rare. They usually present with malena and anaemia, rarely hematemesis. We report a case of leiomyoma of duodenum diagnosed on endoscopic ultrasound that presented with massive haematemesis.