BackgroundDengue is a major health issue with seasonal rise in dengue fever cases imposing an additional burden on hospitals, necessitating bolstering of services in the emergency department, laboratory with creation of additional dengue fever wards.ObjectivesTo study the clinical and hematological profile of dengue fever cases presenting to a hospital.MethodsPatients with fever and other signs of dengue with either positive NS1 antigen test or IgM or IgG antibody were included. Age, gender, clinical presentation, platelet count and hematocrit were noted and patients classified as dengue fever without warning signs (DF) or with warning signs (DFWS), and severe dengue (SD) with severe plasma leakage, severe bleeding or severe organ involvement. Duration of hospitalization, bleeding manifestations, requirement for platelet component support and mortality were recorded.ResultsThere were 443 adults and 57 children between 6 months to 77 year age. NS1 was positive in 115 patients (23%). Fever (99.8%) and severe body ache (97.4%) were the commonest presentation. DF was seen in 429 (85.8 %), DFWS in 55 (11%), SD with severe bleeding in 10 (2%) and SD with severe plasma leakage in 6 cases (1.2%). Outpatient department (OPD) treatment was needed in 412 (82%) and hospitalization in 88 (18%). Intravenous fluid resuscitation was needed in 16 (3.2%) patients. Thrombocytopenia was seen in 335 (67%) patients at presentation. Platelet transfusion was needed in 46 (9.2%). Packed red blood cell (PRBC) transfusion was given in 3 patients with DFWS and 10 of SD with severe bleeding. Death occurred in 3 patients of SD with severe plasma leak and 2 patients with SD and severe bleeding.ConclusionsMajority of DF cases can be managed on OPD basis. SD with severe bleeding or with severe plasma leakage carries high mortality. Hospitals can analyze annual data for resource allocation for capacity expansion.
Variations in the origin of arteries in the abdomen are very common. The arteries that show frequent variations include the celiac trunk, renal arteries, and gonadal arteries. We observed multiple variations in a 45-year-old male cadaver. The variations found on the left side were: one accessory renal artery, two testicular arteries, and middle suprarenal and inferior phrenic arteries that branched from the celiac trunk. On the right side, the inferior phrenic and middle suprarenal arteries arose from the right renal artery.
BACKGROUND: Peritonitis still presents an extremely common & dreaded problem in emergency surgery. Despite aggressive surgical techniques, the prognosis of peritonitis and intra-abdominal sepsis is very poor, especially when multiple organ failure develops. Therefore early objective & reliable classification of the severity of peritonitis and intra-abdominal sepsis is needed not only to predict prognosis & to select patients for these aggressive surgical techniques but also to evaluate & compare the results of different treatment regimens. So, in this prospective study of 60 cases of peritonitis, the reliability of the Mannheim peritonitis index is assessed & its predictive power evaluated. MATERIALS & METHODS: This prospective study was carried out in the department of surgery, GMCH, Udaipur from June 2014 to June 2015 after taking the permission from institutional ethics committee. Patients from both sexes of various age groups having peritonitis of varied aetiology & who had undergone laparotomy were taken. A detailed history, thorough clinical examination & necessary investigations were performed in each case according to planned proforma. After resuscitation laparotomy was done & operative findings were noted carefully and a proper note on the progress of each patient was maintained and any complications encountered were noted. So, early classification of patients presenting with peritonitis by means of objective scoring system was done to select patients for aggressive surgery & overall morbidity & mortality were analyzed. RESULTS: Total 60 patients of peritonitis were examined and common causes were peptic (61.6%), typhoid (21.6%) and appendicular (8.3 %). Most common age group was found to be 21 to 50 years and male to female ratio was 4:1. Peritonitis was more common in patients involved in hard work and chronic Bedi smokers (61.6%). About 46% of patients who presented for treatment within 48 hours of onset of illness mortality was 0% compared to 25% in those who presented after 8 hours. Overall mortality rate was 13.3%. It was highest in the 2 nd decade (25%) followed by the 5 th , 6 th , 7 th decade (16.6% each) of life. Mortality steadily increased with increased in Mannheim peritonitis index score. For patients with a score less than 21 the mortality rate was 0%, for score 21-29 it was 14.2 % and for score greater than 29 the mortality rate was found to be 50%. Patients with a score less than 26 the mean mortality rate was 2.3% and for score greater than 26, it is 38.8%. For a threshold index score of 26, the sensitivity was 87.5% and specificity was 78.8% in predicting death. CONCLUSION: This study reaffirms the value of the Mannheim Peritonitis index in identifying high risk patients with peritonitis.
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