Background and aimDengue fever is an emerging arboviral public health problem in a large endemic population in the tropical and sub-tropical areas of the world, with varying degrees of clinical presentation. This study was aimed at analyzing the clinical and laboratory dynamics of the four dengue serotypes. MethodsThis institutional review board (IRB)-approved hospital-based observational study was performed with 100 in-patients with dengue infection above 12 years of age, without co-morbidities or known malignancy, in a tertiary care center in Northern India. ResultsOut of 100 patients, four had concurrent infection with two serotypes. Dengue virus serotype-2 (DENV 2) was the most common serotype (34%) and had the maximum percentage of cases of severe dengue (20.6%). The mean total leukocyte count did not differ between the serotypes. DENV 4 had a significantly higher mean neutrophil percentage and a significantly lower mean lymphocyte percentage than DENV 1 (p-value 0.001 and 0.02, respectively), with a higher percentage of cases of severe dengue (20% vs 14.3%, nonsignificant). Thrombocytopenia was present in all serotypes of infection. There was a significant difference in the derangement of liver function in DENV 2, 3, and 4 as compared to DENV 1. Mean serum albumin levels were significantly lower in DENV 3 and 4 infections. Cases with co-infection had a much higher derangement of liver function and lower mean serum albumin than infections with a single serotype. The mean blood urea and creatinine levels were in the normal range for all serotypes. No mortality occurred in our study. ConclusionDENV 2 is the most common serotype with maximum severity at our hospital. DENV 2 and DENV 4 have a high percentage of cases with severe dengue (20.6% and 20%, respectively). The mean lymphocyte percentage was significantly lower while hepatic involvement and hypoalbuminemia were greater in DENV 4. Initial serotyping in patients with dengue can help monitor the epidemiological trends and help estimate the clinical and laboratory trends of the different serotypes of dengue infection. Particular care should be taken in patients with co-infection.

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BackgroundHypothyroidism, the commonest form of hormonal dysfunction, is due to thyroid hormone deficiency or its impaired activity. Homeostasis of the metabolism of minerals is regulated by thyroid hormones. If there is any disorder of the thyroid it will lead to disturbances of metabolism of minerals. AimTo study and compare serum calcium and serum phosphorus levels in patients of subclinical hypothyroidism and correlation of these parameters with thyroid-stimulating hormone (TSH) levels. Materials and methodsThis study included 70 patients with subclinical hypothyroidism, 70 patients with overt hypothyroidism, and 70 age-and sex-matched healthy controls. Thyroid profile (estimation of free triiodothyronine [FT3], free thyroxine [FT4], TSH) was done. In both cases and controls serum calcium and serum phosphorus levels were estimated. ResultsSerum calcium and phosphorus levels in patients of subclinical hypothyroidism was 8.75 ± 0.40 mg/dL and 3.80 ± 0.62 mg/dL, respectively. In patients with hypothyroidism it was 8.37 ± 0.52 mg/dL and 4.10 ± 0.75 mg/dL, respectively, and in controls it was 9.67 ± 0.97 mg/dL and 3.70 ± 0.71 mg/dL, respectively. Difference between these groups was statistically significant (p<0.05 ). Mean serum calcium and phosphorus for patients with TSH level <10 was 8.81 ± 0.33 mg/dL and 3.67 ± 0.60 mg/dL, respectively, and for TSH level >10 was 8.59 ± 0.51 mg/dL and 4.12 ± 0.54 mg/dL, respectively. The difference between both groups was statistically significant (p<0.05) for calcium, phosphorus . ConclusionsIn subclinical hypothyroidism serum calcium and serum phosphorus levels are significantly altered. Regular follow-up and estimating serum levels of these minerals in subclinical hypothyroidism patients should be done so it is beneficial to give mineral supplementations to prevent bone complications during the treatment of the disease.

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Granulomatosis with Polyangiitis (GPA) can present with Cerebral Venous Sinus Thrombosis (CVST), Chronic Suppurative Otitis Media, and Lower Motor Neuron (LMN) Facial Palsy. However, an association between CVST and Hyperhomocysteinemia in GPA has not previously been reported. Here, we report a case of CVST and Hyperhomocysteinemia in Proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) positive GPA without renal involvement.