Is Ultrasound a Useful Tool to Predict Severe Dengue Infection?

OBJECTIVES: To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. METHODS: This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry. RESULTS: Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4 %) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of <0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count <50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge. CONCLUSIONS: Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.

Unusual complication of toxic megacolon in typhoid colitis.

Colitis is a rare manifestation of enteric fever in children. Toxic megacolon complicating typhoid colitis is even rarer and requires early recognition and aggressive management due to the high mortality associated with this condition. The authors report a rare case of Toxic megacolon secondary to typhoid colitis in a seven-year-old girl.

Prevalence of malnutrition in rural Karnataka, South India: a comparison of anthropometric indicators.

Malnutrition is a problem at varying proportions in developing countries, and anthropometry is a simple tool to assess its magnitude in children. This study was aimed at identifying the prevalence of malnutrition among 256 children of rural areas of Karnataka in South India, who attended the aanganwadis. The value of using various field-based formulae and of various anthropometric indicators used for classification of malnutrition was also studied. The children, aged 12-60 months, came from villages located at the outskirts of Bangalore city. The prevalence of wasting, stunting, and wasting and stunting was 31.2%, 9.4%, and 29.2% respectively. Wasting was more predominant among the younger age groups (p<0.01). To detect wasting (acute malnutrition), the best indicator was a comparison with the reference weight calculated using Weech's formula. However, the age of child had to be rounded off to the nearest quarter of a year. Results of the study showed that indicators, such as mid-upper arm circumference (MUAC), needed to be used with caution since they are not sensitive enough to detect all cases of malnutrition. However, the MUAC-for-height (quac stick) method could be used since it was more sensitive. For detection of stunting, if reference tables are not available, Weech's formula can be used for calculation of expected height taking care to account for age to the nearest quarter, although the sensitivity of this indicator is not very high.