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Expanded dengue syndrome is a severe form of dengue fever that can cause acute liver failure and patients with this condition have a high mortality rate. This is because it can cause a cytokine storm, Unfortunately, standard treatments are often ineffective. Therapeutic plasma exchange is a procedure that removes cytokines and improves the patient's condition. Our study involved 15 patients with expanded dengue syndrome having acute liver failure, who were not responding to standard therapies. We treated them with plasmapheresis, and 11 of the patients showed significant improvement in liver function and survived. Unfortunately, the remaining four patients died owing to other complications. Early treatment is crucial for the best possible outcome.
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BACKGROUND: Electrocution is a common cause of mild to severe multisystem injuries leading to high rate of mortality and morbidity. Low to high-voltage injury may be clinically manifested from a simple unpleasant sensation to multiple soft tissue injury which may cause instant death. The severity of injury depends on intensity of the electrical current, voltage of the source, resistance in the victims' body and the duration of the contact. CASE PRESENTATION: A 20-year-old young male experienced with an accidental high-voltage electrocution injury from a blasted electrical transformer while passing across the road. He lost his consciousness and immediately hospitalized. Bilateral pulmonary infiltrates and right cerebellar hemorrhage with fractures in anterior and posterior arch of the first cervical vertebrae (C1) were diagnosed, and there was no history of electrical burn. He stayed in hospital for three days and completely treated with initial oxygen supplementation and immobilization of his head and neck with a Philadelphia collar for 6 weeks. Electrocution is a serious public health concern and reported worldwide with few fatal ending. Accidental high-voltage electrocution injury is a serious type of unfortunate accidental injuries which in most of times, ends with immediate or delayed sequelae or even death. In this case, the victim with high-voltage-associated electrical injuries in his lungs and brain was completely recovered because of early hospitalization. CONCLUSIONS: Electrocution injury is an accidental event with high mortality and morbidity rate. Mild to severe electrical current-induced injuries including burn can be treated successfully in most of the cases, but early hospitalization is highly required.
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INTRODUCTION: Alcaligenes faecalis is a species of gram-negative, rod-shaped, aerobic bacteria commonly found in the environment. A. faecalis-associated nosocomial infections are common in hospitalized patients, but serious life threatening infections are rare. Here, we report a rare case of BSI with A. faecalis resistant to all available antibiotics; successfully treated with double-dose of tigecycline. PRESENTATION OF CASE: A 60-year-old female presented with A. faecalis bloodstream infection, where the organism was completely resistant to all commercially available antibiotics including polymyxins and tigecycline. The physical condition of the patient was deteriorating and there were no active antibiotics available to prescribe based on sensitivities. Despite the organism's resistance to tigecycline, double-dose of tigecycline therapy (100 mg twice daily, intravenously after a 200 mg single intravenous loading dose) was prescribed intentionally for the treatment of this infection. The organism was completely eradicated from the bloodstream of that patient within the 5 days of therapy-initiation. DISCUSSION: Double-dose of tigecycline maintains a higher serum drug concentration rather than the standard dose, and in this case, double-dose of tigecycline completely cleared the pandrug-resistant A. faecalis from the blood where initially, that organism was resistant to tigecycline. Previously, A. faecalis isolates were found resistant to fluoroquinolones, but here it was found very rarely resistant to even reserve antibiotics, polymyxins, carbapenems and tigecycline. CONCLUSION: Pandrug-resistant A. faecalis-associated bloodstream infection is a very uncommon case and double-dose of tigecycline may be an effective option to treat it.