Unveiling the Neurotoxicity of Metronidazole: A Clinical Conundrum.

Metronidazole, a commonly used antiprotozoal agent, has been linked to neurotoxicity in a few individuals. We present the case of a 61-year-old gentleman diagnosed with a liver abscess, who received a total dose of 64 g of metronidazole over a four-week duration. He subsequently developed slurred speech, numbness, and tingling sensation in both feet. His neuroimaging revealed T2 hyperintensities in the bilateral dentate nuclei and withdrawal of the drug led to symptomatic improvement in the patient. Metronidazole is known to produce neurological manifestations with involvement of peripheral nerves and cerebellum commonly. In the present case, the cumulative dose impact of metronidazole on the dentate nucleus was evident.

Chyluria in a Postpartum Obese Female Patient.

Chyluria characterized by the passage of milky white urine is rarely encountered these days due to the overall reduction in the number of cases of lymphatic filariasis. Though lymphatic filariasis accounts for the majority of cases of chyluria, nonparasitic causes have also been reported. Case reports of chyluria as a complication in pregnancy have been published but chyluria presenting solely as a postpartum complication has rarely been documented. We present a case of a 29-year-old female with no known prior comorbidities, who presented with recurring complaints of the painless passage of milky white urine over the last year. Symptoms seem to have started six months post-delivery of her second child. The patient claimed significant weight gain during an otherwise normal pregnancy. She was well-built and had a BMI of 32 kg/m2. Her systemic examination and baseline laboratory workup were within normal limits. Postprandial urine was milky white, rich in chylomicrons, with urine chylomicrons of 112 mg/dl. The patient was screened for filariasis, which was negative. An ultrasound of the abdomen was done to rule out the presence of a fistula, but no evidence of one was found on imaging. Tc-99m sulfur colloid scintigraphy revealed an area of abnormal tracer accumulation in the abdomen with the passage of the tracer in the urine container, confirming the presence of chyluria. The patient was recommended to undergo conservative management with dietary modification and weight reduction. She has been closely followed up and has achieved spontaneous resolution of the chyluria. Most patients with chyluria show a good response to conservative management alone as in our case. Surgical intervention is usually indicated for cases not responding to conservative management or for refractory chyluria.

Recurrent Young Stroke With Hemianopia.

Homocysteine is a toxic, sulphur-containing intermediate of methionine metabolism. Hyperhomocysteinemia has been proposed as an important risk factor for ischemic stroke. We present the case of a 39-year-old male who sustained a cerebrovascular accident with left hemiparesis two years back; the patient was not compliant with his medications, and now presented with complaints of giddiness, reduced vision, and double vision. Vision disturbances were bilateral, acute in onset, progressive over time, and predominantly affected the peripheral vision. On ophthalmic examination, homonymous hemianopia was noted, and finger counting was absent in both eyes. Confrontation test revealed a bilateral reduced field of vision more so in the left eye. Baseline investigations were unremarkable except for mildly elevated serum. Homocysteine and neuroimaging showed acute infarct with hemorrhagic transformation in the right occipito-parietal region and small acute non-hemorrhagic infarcts in the right thalamus and right side of the splfingerenium of the corpus callosum. Given the visual disturbance, Humphrey visual field (HVF) perimetry was done and it revealed left homonymous congruous hemianopia, likely due to right parietal lobe infarct. The patient had recurrent infarcts previously involving anterior and posterior circulation.

Salivary 1,5-Anhydroglucitol and its Correlation with Postprandial Hyperglycemia: Development and Validation of a Novel Assay.

Background: Saliva has the potential to be used as a noninvasive sample for testing hyperglycemia in diabetes mellitus. Serum 1,5-anhydroglucitol (1,5-AG) decreases with an increase in blood sugar >180 mg/dl. We hypothesized that salivary 1,5-AG can be used to identify blood sugar higher than 180 mg/dl using a novel biochemical method. Aim: This study aimed to develop a novel biochemical method for serum and salivary assessment of 1,5-AG and assess its correlation with postprandial blood sugar (PPBS) >180 mg/dl. Methodology: The study comprised 45 controls (healthy individuals) and 45 cases (type 2 diabetic patients with PPBS >180 mg/dl). Blood and salivary samples were collected according to the study protocol. A new method was developed for the quantification of 1,5-AG in serum and saliva using liquid chromatography-mass spectrometry. Results: The value of serum (mean -22.19 µg/ml and median -22.12 µg/ml) and salivary (mean -0.124 µg/ml and median -0.088 µg/ml) 1,5-AG was higher in healthy individuals compared to corresponding serum (mean -3.89 µg/ml and median -2.52 µg/ml) and salivary (mean -0.025 µg/ml and median - 0.025 µg/ml) levels in diabetics with PPBS >180 mg/dl. In diabetics, a significant negative correlation was noticed with PPBS levels and 1,5-AG levels in serum and saliva. Salivary 1,5-AG level <0.054 µg/ml had an 86.4% sensitivity and 87.2% specificity in predicting a blood sugar value >180 mg/dl. Conclusion: The results of our study suggest that the short-term glycemic marker 1,5-AG can be detected in saliva and can be useful as an adjunct marker in monitoring of glycemic status in diabetic patients.

Candidate Gene Expression in Regional Population and Its Relevance for Radiation Triage.

Quantification of gene expression signatures has been substantiated as a potential and rapid marker for radiation triage and biodosimetry during nuclear emergencies. Similar to the established biodosimetry assays, the gene expression assay has drawbacks such as being highly dynamic and transient, not specific to ionizing radiation, and also influenced by confounding factors such as gender, health status, lifestyle, and inflammation. In view of that, prior knowledge of baseline expression of certain candidate genes in a population could complement the discrimination of the unexposed from the exposed individuals without the need for individual pre-exposure controls. We intended to establish a baseline expression of reported radiation-responsive genes such as CDKN1A, DDB2, FDXR, and PCNA in the blood samples of healthy human participants and then compare it with diabetic/hypertension participants (as a chronic inflammatory condition) drawn from south Indian population. Further, we have examined the appropriateness of the assay for radiation triage-like situations; i.e., the expression profiles of those genes were examined in the participants who underwent X-ray-based medical imaging. Acute inflammation induced by lipopolysaccharide exposure in the blood significantly increased the fold expression of those genes (p < 0.0001) compared to the control. Whereas the basal expression level of those genes among the participants with the inflammatory condition is marginally higher than those observed in the healthy participants; despite the excess, the fold increase in those genes between the groups did not differ significantly. Consistent with the inflammatory participants, the basal expression level of those genes in the blood sample of participants who received X-radiation during neuro-interventional and computed tomography imaging is marginally higher than those observed in the pre-exposure of respective groups. Nevertheless, the fold increase in those genes did not differ significantly as the fold change fell within the two folds. Thus, overall results suggest that the utility of CDKN1A, DDB2, FDXR, and PCNA gene expression for radiation triage specific after very low-dose radiation exposure needs to be interpreted with caution for a much more reliable triage.

Outcomes of COVID-19 Among High-Risk Individuals: A Study Comparing Febrile and Afebrile Presentation.

Background: Fever is one of the most frequent symptoms of coronavirus disease 2019 (COVID-19) and clinicians are faced with a practice question on whether fever is a risk for progression of disease especially in persons with risk factors for severe illness. We studied if a difference exists in the clinical course and outcome between febrile and afebrile (symptomatic) presentation. Methods: Patients aged > 18 years with confirmed COVID-19 with at least one risk factor for severe illness were studied. Enrolment was done from a home COVID-19 care cohort between May 2020 and March 2022. Participants were divided into febrile and afebrile groups and further divided into six sub-groups based on their comorbidities (diabetes mellitus, hypertension, chronic lung disease, chronic kidney disease, liver disease and others) using a pre-specified inclusion method. Severity of illness was classified as non-hypoxic or hypoxic and clinical course was monitored. Results: A total of 3,752 patients were studied, of whom 965 (25.7%) had severe illness and 117 (3.1%) died. Persons with obesity (P < 0.001), chronic kidney disease (P = 0.003) and chronic liver disease (P = 0.02) more frequently had presentation without fever. No significant difference in hypoxia (P = 0.35) or mortality (P = 0.50) was observed between febrile (n = 1,240) and afebrile (n = 2,512) presentation. Conclusion: Fever in COVID-19 was not associated with severe illness or mortality. The overall and risk factor specific mortality observed in our study is substantially low, probably due to lesser bias in selection of study participants or due to ethnicity of study population.

Comparison of Fasting Insulin Level, Homeostatic Model of Insulin Resistance, and Lipid Levels between Patients with Primary Hypertension and Normotensive Subjects.

BACKGROUND: Hyperinsulinemia and insulin resistance occurs in obese patients with primary hypertension independent of diabetes and obesity. This study was aimed at assessing serum fasting insulin levels, the homeostatic model assessment for insulin resistance (HOMA-IR), and serum lipid levels in non-obese patients with primary hypertension when compared to normotensive subjects. METHODS: This observational study comprised 100 patients over 18 years of age, divided into two groups. The hypertensive group comprised non-obese patients with primary hypertension (n=50); the normotensive group comprised normotensive age- and sex-matched individuals (n=50). Patients with diabetes, impaired fasting glucose, obesity, and other causative factors of insulin resistance were excluded from the study. Serum fasting insulin levels and fasting lipid profiles were measured, and insulin resistance was calculated using HOMA-IR. These data were compared between the two groups. Pearson's correlation coefficient was used to assess the extent of a linear relationship between HOMA-IR and to evaluate the association between HOMA-IR and systolic and diastolic blood pressures. RESULTS: Mean serum fasting insulin levels (mIU/L), mean HOMA-IR values, and fasting triglyceride levels (mg/dL) were significantly higher in the hypertensive versus normotensive patients (10.32 versus 6.46, P<0.001; 1.35 versus 0.84, P<0.001; 113.70 versus 97.04, P=0.005, respectively). The HOMA-IR levels were associated with systolic blood pressure (r value 0.764, P=0.0005). CONCLUSION: We observed significantly higher fasting insulin levels, serum triglyceride levels, and HOMA-IR reflecting hyperinsulinemia and possibly an insulin-resistant state among primary hypertension patients with no other causally linked factors for insulin resistance. We observed a significant correlation between systolic blood pressure and HOMA-IR.

Role of secondary sepsis in COVID-19 mortality: Observations on patients with preexisting diabetes mellitus and newly diagnosed hyperglycemia.

Diabetics who develop severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) are more likely to have severe disease, higher odds of intensive care requirement and mortality. Fifteen percent of patients have new onset hyperglycemia. We studied the comparative outcomes between prior DM, newly detected hyperglycemia and assessed role of secondary sepsis on mortality. RWe performed a r etrospective study of confirmed SARS-CoV-2 patients at a tertiary care hospital in Chennai, India. Patients were divided as 2 groups (Group 1: With preexisting diabetes mellitus, Group 2: With newly diagnosed hyperglycemia due to newly detected diabetes mellitus or non-diabetic hyperglycemia. Clinical and laboratory data was analysed. Two hundred and thirty eight patients had prior-diabetes mellitus (Group 1) and 40 had newly diagnosed hyperglycemia (Group 2). Thirty four of group 1 and 7 of group 2 patients required intensive care. Mean capillary blood glucose (MCBG) during hospital stay was 207 mg/dl (Group 1) and 192 mg/dl (Group 2). Twentysix patients (9.3%) had secondary sepsis of which sixteen died. Logistic regression identified secondary sepsis(p<0.0001), elevated D-dimer >6 fold (p= 0.0001), elderly p=0.0045), male (p=0.0006), NLR >5 (p=0.01),serum creatinine ≥2 mg/dl (p=0.0004), FiO2 requirement >0.6 in first 48 hours (p=0.001) as mortality predictors.Our study observed a 14.38 % prevalence of newly diagnosed DM or non-diabetic hyperglycemia. Secondary sepsis and >6 fold elevation in D-dimer were strong predictors of mortality. Steroid use possibly contributed to secondary sepsis. Early identification and aggressive management of secondary sepsis are necessary for diabetics.

Bedside Scoring System for Predicting Adverse Outcomes Among Patients Suffering From SARS-CoV-2 Infection.

Aim To develop a clinical risk score to predict adverse outcomes among diabetic hospitalized COVID-19 patients Methods The data was collected retrospectively from patients hospitalized with the SARS-CoV-2 virus at Sri Ramachandra Institute of Higher education and research. It integrated independent variables such as sex, age, glycemic status, socioeconomic status, and preexisting lung conditions. Each variable was assigned a value and the final score was calculated as a sum of all the variables. The final score was then compared with patient outcomes. The patients were scored from 0 to 8 and a score of 3 or more was considered as being at greater risk for developing complications. Number of mortalities in each group, any clinical deterioration requiring ICU admission, and the number of patients requiring a prolonged hospital stay of more than 10 days in each group were noted and the results compared. Results Higher blood glucose levels and preexisting lung conditions like chronic obstructive pulmonary disease (COPD), asthma, and pulmonary tuberculosis have been associated with a higher risk of developing complications related to SARS-CoV-2 illness. Of the 5023 patients enrolled in the study, 2402 had a score of 2 or below, and 2621 had a score of 3 or above. Among patients with a score of 2 or below 1.7% of the patients contracted a severe disease resulting in death. 2.9% were shifted to ICU, but recovered and 12.2% of patients had a prolonged hospital stay. Of those with a score of 3 or greater, 5.1% died, 7.36% were shifted to ICU, but recovered, and 19.5% required a prolonged hospital stay. The observed results were analyzed using the Chi-square test and were found to be significant at a p-level of 0.0001. Conclusion This clinical risk score has been built with routinely available data to help predict adverse outcomes in diabetic patients hospitalized with the SARS-CoV-2 virus. It is a good tool for resource-limited areas as it uses readily available data. It can also be used for other severe acute respiratory illnesses or influenza-like illnesses.

Post-acute Sequelae of SARS-CoV-2 Infection: Do Indians Fare Better?

INTRODUCTION: The uplift of SARS-CoV-2 infection has necessitated the understanding of long-term consequences in the affected population. This study was driven by a lack of Indian studies to estimate the torment of post-coronavirus disease 2019 (COVID-19) symptoms and the quality of life. METHODS:  This prospective observational study was conducted in a tertiary care centre in South India, between August and November 2020. SARS-CoV-2 hospitalised patients were telephonically questioned regarding the persistence of symptoms along with an assessment of the quality of life using the 15D questionnaire in the first, second, and fourth weeks. Since a majority of the patients had resolution of symptoms by four weeks, the study was not extended for a longer period. RESULTS: The study included 476 patients whose mean length of hospital stay was 7.67 days. Of the patients, 68.7% had mild severity, 24.8% had moderate disease, and 6.5% had severe disease. About 28.4% required oxygen, 8.2% required ICU care, and 1.3% required mechanical ventilation. Myalgia (13.9%), cough (1.3%), and dyspnoea (6.1%) were the predominant persistent symptoms in the fourth-week post-discharge. All the symptoms of health-related quality of life and physical performance improved by the fourth week, which was statistically significant. CONCLUSION: Our study findings are in stark contrast to the studies published from other regions of the world, which show a significant worsening of quality of life even among those with mild illness.

Course of COVID-19 Based on Admission D-Dimer Levels and Its Influence on Thrombosis and Mortality.

BACKGROUND: Arterial and venous thrombosis is one of the major complications of coronavirus disease 2019 (COVID-19) infection. Studies have not assessed the difference in D-dimer levels between patients who develop thrombosis and those who do not. METHODS: Our study retrospectively assessed D-dimer levels in all virus confirmed hospitalized patients between May to September, 2020. Patients were divided into three groups: group 1 with normal D-dimer of < 0.5 µg/mL, group 2 with elevation up to six folds, and group 3 with more than six-fold elevation. Statistical analysis was done using SPSS software 23.0. RESULTS: Seven hundred twenty patients (group1 (n = 414), group 2 (n = 284) and group 3 (n = 22)) were studied. Eight thrombotic events were observed. Events were two with stroke, two non-ST elevation myocardial infarction and one each of ST elevation myocardial infarction, superior mesenteric artery thrombosis with bowel gangrene, arteriovenous fistula thrombus and unstable angina. No significant difference (P = 0.11) was observed between median D-dimer levels among patients who developed thrombosis (1.34) and those who did not develop thrombosis (0.91). Twenty-nine patients died. The adjusted odds of death among those with a six-fold or higher elevation in D-dimer was 128.4 (95% confidence interval (CI): 14.2 - 446.3, P < 0.001), while adjusted odds of developing clinical thrombosis was 1.96 (95% CI: 0.82 - 18.2, P = 0.18). CONCLUSIONS: Our study observed a 1.1% in-hospital incidence of clinical thrombosis. While, a six-fold elevation in D-dimer was significantly associated with death; the same was not a strong predictor of thrombosis; an observation which implies that dose of anticoagulation should not be based on absolute D-dimer level.

Low secondary transmission rates of SARS-CoV-2 infection among contacts of construction laborers at open air environment.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads through droplet and aerosols. Household contacts have a high risk of infection and transmission outside the home can occur at closed and open locations. We studied the transmission risk at open environment among contacts of construction laborers. METHODS: Close contacts of 18 SARS-CoV-2 infected construction laborers were assessed for symptomatic or asymptomatic infection. Contacts were classified as: a) persons at residence of index case b) persons at workplace (open and closed environment), and c) persons outside the index case residence or workplace who are traceable. Relative risk of infection among contacts at different locations and observed parameters were compared between them. RESULTS: Four hundred and ninety-six contacts were assessed. The secondary transmission rate was maximum among household contacts (n=28, 43.7%) followed by contacts at closed environment at workplace (n=44, 26%), traceable other contacts (n=8, 15.7%) and contacts at open environment at workplace (n=3, 1.4%). Relative risk of SARS-CoV-2 infection among household contacts was 30.9 (CI 9.7-98.3, p<0.001) compared to open environmental work contacts and 1.68 (CI 1.15-2.44, p=0.006) compared to closed environmental work contacts. Relative risk was 18.3 (CI 5.8-58.2, P<0.001) among closed environmental work contacts compared to open environmental work contacts. One index and one secondary case died. CONCLUSIONS: The low secondary transmission rate of SARS-CoV-2 infection among open environmental contacts emphasizes the fact that free air flow has the ability to dilute or probably blow away the virus particles and lowers the transmission risk substantially.

Endothelial Microparticle as an early Marker of Endothelial Dysfunction in Patients with Essential Hypertension: A Pilot Study.

Hypertension is a global health burden causing immense morbidity and mortality especially from the complications of end-organ damage. It is expected to affect 29% of the population by the year 2025. Hypertension is usually asymptomatic; it is diagnosed by a disease of exclusion. Numerous factors such as inflammation, oxidative stress, genetic predisposition etc. play roles in the pathogenesis of hypertension. Endothelial microparticles (EMPs) are released into the circulation with the onset of changes in endothelium, even before the release of other routine vascular endothelial markers. EMPs mediate inflammation, thrombosis and vasoconstriction of blood vessels in hypertensives. This pilot study was undertaken to assess whether EMPs are early markers of endothelial dysfunction in essential hypertensive patients. The study was conducted as a large case control study in which 525 individuals were involved. It consisted of three study groups: Group I: individuals with normal blood pressure (JNC8), group II: hypertensives without evidence of end-organ damage and group III: hypertensives with evidence of end-organ damage. Homocysteine, hsCRP, fibrinogen, eNOS, oxLDL and other markers were measured. For analysis of EMPs a subset of individuals are taken from each group. Control group of 10 individuals who had homocysteine level more than15µmol/L was taken as Group I. Another 10 individuals were taken randomly of five each from groups II and III. EMPs were analyzed by flow cytometry and were identified as CD31 +, CD42 - microparticles with diameters < 1.0 mm. There was significant increase in EMPs (p = 0.035) in hypertensive individuals with end organ damage. Measurement of EMPs in hypertensive individuals could help physicians in identifying and initiating therapeutic interventions at a very early stage of the disease, thus improving the quality of life.

Effect of Platelet Transfusion on Clot Strength in Dengue Fever with Thrombocytopenia Related Bleeding: A Thromboelastography-Based Study.

Platelet transfusions are often administered in dengue illness complicated by thrombocytopenia-related bleeding. However, whether this practice results in an improvement of clot strength is not clear. This study assessed the impact of platelet transfusion on the control of bleeding and improvement in clot strength as assessed by thromboelastography among 74 patients with dengue. The effect of either weight-based random donor platelets or 1 unit of single donor aphaeresis units was studied. Transfusion of weight-based random donor platelets resulted in a mean platelet count increase of 10,210 cells per mm3 at 24 h from pretransfusion values, which reached marginal statistical significance (p = 0.031). Patients who received single donor platelets achieved a mean platelet increment of 22,874 cells per mm3 at 24 h, and the difference observed had a high statistical significance (p < 0.001). However, no significant improvement in clot strength was observed in thromboelastography. The mean increment in maximum amplitude value at 24 h was only 2 mm in the random donor platelet group and 5 mm in the single donor group, both of which did not reach statistical significance. Furthermore, the majority of patients had ongoing bleeding despite the administration of platelets. This study observed that platelet transfusion in dengue patients with bleeding complication improved the absolute platelet count with no improvement in clot strength.

Estimation of Upper Limit of Normal for Serum Alanine Transaminase in Healthy South Indian Population.

Alanine aminotransferase (ALT) is the most common and cost effective screening test for asymptomatic liver disease. There is paucity of data on normal ALT among healthy individuals in India. An observational cross sectional study was conducted from January to July 2013 to estimate the upper limit of normal for ALT in healthy south Indian population. Adults undergoing voluntary or pre-employment health screening were included. Those with current and past alcoholism or smoking, acute illness or hospitalization during preceding 12 months, non-steroidal anti-inflammatory or over the counter medication use within a month, current or past intake of herbal medications, any chronic medical illness, abnormal body mass index (BMI), fatty liver in ultrasound, abnormality in haemoglobin, platelet count, blood sugar, creatinine, lipid profile and thyroid function test and positive serology (Hepatitis B, C or HIV) were excluded. A total of 2600 subjects were screened. 344 were included for analysis. Mean age was 35 years in men and 34.83 years in women, with a mean BMI of 22.2 kg/m2 in men and 21.8 kg/m2 in women. The mean ALT in men and women were 21.87 ± 2.9 (97.5th percentile 28 U/L) and 19.35 ± 3.3 (97.5th percentile 24 U/L) respectively. In conclusion, mean and upper limit of ALT (97.5th percentile) in south Indian men was 21.87 and 28 IU/L and women were 19.35 and 24 IU/L respectively. There is a need to re-consider ALT levels in our population for better detection of individuals at risk for liver disease.

Low dose short duration pulsed electromagnetic field effects on cultured human chondrocytes: An experimental study.

BACKGROUND: Pulsed electromagnetic field (PEMF) is used to treat bone and joint disorders for over 30 years. Recent studies demonstrate a significant effect of PEMF on bone and cartilage proliferation, differentiation, synthesis of extracellular matrix (ECM) and production of growth factors. The aim of this study is to assess if PEMF of low frequency, ultralow field strength and short time exposure have beneficial effects on in-vitro cultured human chondrocytes. MATERIALS AND METHODS: Primary human chondrocytes cultures were established using articular cartilage obtained from knee joint during joint replacement surgery. Post characterization, the cells were exposed to PEMF at frequencies ranging from 0.1 to 10 Hz and field intensities ranging from 0.65 to 1.95 µT for 60 min/day for 3 consecutive days to analyze the viability, ECM component synthesis, proliferation and morphology related changes post exposure. Association between exposure doses and cellular effects were analyzed with paired't' test. RESULTS: In-vitro PEMF exposure of 0.1 Hz frequency, 1.95 µT and duration of 60 min/day for 3 consecutive days produced the most favorable response on chondrocytes viability (P < 0.001), ECM component production (P < 0.001) and multiplication. Exposure of identical chondrocyte cultures to PEMFs of 0.65 µT field intensity at 1 Hz frequency resulted in less significant response. Exposure to 1.3 µT PEMFs at 10 Hz frequency does not show any significant effects in different analytical parameters. CONCLUSIONS: Short duration PEMF exposure may represent a new therapy for patients with Osteoarthritis (OA).

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.