Dengue among Suspected Patients Admitted to Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Dengue virus incidence has been increasing trends in every year due to the expansion of the vectors Aedes aegypti and Aedes albopictus. The objective of this study was to find out the prevalence of dengue among suspected patients admitted to the department of medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the medicine department from 30 September 2022 to 30 December 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 019/2022). Demographic, clinical characteristics and laboratory profiles were collected from dengue patients by using a structured questionnaire. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 500 patients, 242 (48.40%) (40.66-56.14, 95% Confidence Interval) were found to be dengue positive. The average age of the enrolled patients was 39.13±20.64 years. Most dengue fever patients were diagnosed in the category of dengue with a warning sign of 234 (96.69%). The mean hospital stay of dengue patients was 4.05±2.03 days, 229 (94.62%) of patients stayed less than 7 days before discharge. Conclusions: The prevalence of dengue among suspected patients admitted to the department of medicine is found to be higher than in other similar studies done in similar settings. Patients with clinical symptoms and laboratory findings corroborating with dengue should undergo early diagnosis and facilitate prompt treatment in individual patients. Keywords: dengue virus; public health; tertiary care centre.

Rituximab for acute plasma-refractory thrombotic thrombocytopenic purpura: A case report.

Introduction and importance: Thrombotic thrombocytopenic purpura (TTP) is a rare disease due to deficiency of ADAMTS13 which can present with anemia and thrombocytopenia. The study highlights the role of PLASMIC score in diagnosis and rituximab in the treatment of this condition. Case presentation: Herein, we report a case of 38 years old female who had presented with fever, irritability, and altered sensorium. On investigations, she had hemolytic anemia, and thrombocytopenia with peripheral blood smear showing occasional schistocytes and managed with steroids and plasma exchange. As her platelet, LDH, and a few other lab parameters failed to normalize and met the criteria of refractory TTP, hence she was started on 5 cycles of rituximab and her condition improved. Clinical discussion: Thrombotic thrombocytopenic purpura can be presumed based upon PLASMIC score where if the score is 5 or more while ADAMTS13 assay is required for confirmation. It is a life-threatening condition where treatment options include therapeutic plasma exchange (PEX), glucocorticoids, Rituximab, and caplacizumab. Rituximab is considered particularly in refractory cases. Conclusion: Thrombotic thrombocytopenic purpura can lead to complications due to low platelet counts. Hence, early diagnosis and intervention are crucial to prevent such complications.

Pseudomonas aeruginosa as a culprit of cervical necrotizing fasciitis: A case report.

INTRODUCTION AND IMPORTANCE: Necrotizing fasciitis is usually a polymicrobial infection and odontogenic source is usually the foci for infection in the neck region. Cervical necrotizing fasciitis due to Pseudomonas is a rare and potentially fatal complication in diabetic patients. The study highlights the importance of early intervention to improve the outcome of the patient. CASE PRESENTATION: We report a case of a 48-year female who presented with neck pain for 10 days. On further investigations, she had diabetic ketoacidosis, and a culture of the wound showed Pseudomonas. With appropriate antibiotics and surgical intervention, her condition gradually improved. CLINICAL DISCUSSION: Necrotizing fasciitis in the neck region with Pseudomonas without odontogenic infections is a rare occurrence. Early medical and surgical intervention leads to a better outcome. The location of the infection and its extensions can affect the prognosis. CONCLUSION: Physicians should be aware of cervical necrotizing fasciitis as a complication in diabetic ketoacidosis and install early treatment to improve survivability and the outcome.