Prevalence, patterns, and factors associated with bleeding tendencies in dengue.

INTRODUCTION: The pattern of bleeding tendencies in dengue and its corellation with platelet count and other factors requires clarification. METHODOLOGY: A retrospective study on bleeding tendencies in adults with dengue and platelet counts of less than 100,000 per mm(3) was conducted. Factors associated with bleeding were analyzed. The study cohort were grouped as dengue with severe thrombocytopenia when platelet count was < 50,000/mm(3) and as dengue with moderate thrombocytopenia if platelet count was 50,000-100,000/mm(3) RESULTS: A total of 638 patients formed the study cohort. A 24.1% prevalence of bleeding tendencies was observed. Prior anti-platelet drug intake, platelet count of < 70,000/mm(3), international normalized ratio > 2.0, and partial thromboplastin time > 60 seconds were associated with bleeding. Esophagogastroduodenoscopy was found to identify structural gastroduodenal lesions when dengue was complicated by hematemesis or melena. CONCLUSIONS: The results of this study suggest that bleeding complications in dengue can occur at platelet counts of up to 70,000/mm(3), and that prior anti-platelet drug intake increases bleeding risk. Evaluation of hematemesis or melena in dengue with esophagogastroduodenoscopy is beneficial.

Ischaemic stroke with internal carotid artery occlusion following viper bite: A case report

Snake bites are an important cause of morbidity and mortality in tropical countries. Neurological complications are quite common in venomous snake bites. Strokes, mainly haemorrhagic and occasionally ischaemic, have been reported in 2.6% of snake bites. Direct effect of toxin, vasospasm and release of procoagulant and anticoagulant factors have all been postulated as the cause. However thrombotic stroke with involvement of a major cerebral vessel is very rare. We report a case of complete left internal carotid artery occlusion with ischaemic stroke in a young lady after a Russel’s viper bite.