Acute respiratory distress syndrome (ARDS) is a disease, mainly occurring in critically ill patients. The systemic spread of infections mainly causes ARDS due to the seepage of fluid in the spaces of the lung . Scrub typhus is a infection caused by . The bite of mite transmits it. Scrub typhus is frequently due to its non-specific clinical presentation and relatively low level of suspicion in treating physicians. The clinical presentation of scrub typhus is varied from fever, , rashes, headache, to pneumonia, acute respiratory distress syndrome, sepsis, central nervous system involvement. The disease is usually indistinguishable from other febrile illness like enteric fever, disease, malaria and certain viral hemorrhagic fevers. Identification of an points to the diagnosis without which the diagnosis is based on a high index of clinical suspicion. We report an interesting case of scrub typhus presenting as acute respiratory distress syndrome.
Chronic kidney disease (CKD) is said to be the presence of renal damage with or without compromised renal function. Chronic renal failure (CKD) affects almost all systems of the body and results in various abnormalities, leaving significant morbidity and mortality. Of the various causes, infection and cardiovascular events contribute towards a large proportion of its occurrences. The most common cause of death in Chronic Kidney disease patients is due to cardiovascular disease. Left ventricular hypertrophy and Coronary artery disease are considered to be the two major cardiovascular disorders among CKD patients. The present study is aimed at assessing the prevalence of cardiac abnormalities among the asymptomatic chronic tubulointerstitial syndrome (CTIS) patients by echocardiography. The parameters studied to detect the cardiac abnormalities are Regional Wall Motion Abnormality (RWMA), Interventricular wall thickness (IVWT), Posterior ventricular wall thickness (PVWT), Ejection Fraction (E.F.), Fractional Shortening (F.S.), E/A ratio, Valvular lesions, Pericardial Effusion. Of the above parameters, Interventricular wall thickness, Posterior ventricular wall thickness, Ejection Fraction, Fractional shortening and E/A ratio had significant association among the patients with asymptomatic CTIS. Left ventricular hypertrophy was observed among 64.7% of the patients. Ejection fraction <50% is seen among 83.8% of the study population, 83.8% had abnormal E/A ratio, and 67.6 % had abnormal fractional shortening. In conclusion, CTIS in various stages of CKD has asymptomatic echocardiographic abnormalities which have to be kept in mind as it has an impact on mortality and morbidity.
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