Clinical audit of dengue related deaths in 2011 at mayo hospital lahore pakistan

Background and Objective: Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia's ancient hospital setting with an aim to recognize complications at earliest and improve case management in future

Methods: A retrospective observational study of 95 adult dengue deaths was performed at Mayo Hospital Lahore from July 1st 2011 to 31st December 2011 during a major dengue epidemic. Patients who tested positive by dengue IgM in the presence of acute fever fulfilling the World Health Organization criteria for Dengue Fever, Dengue Hemorrhagic Fever or Dengue Shock Syndrome and died within same setting, were included. Data regarding demographic profile, clinical and laboratory parameters along with treatment details were obtained and analysed. All records examined were anonymized

Results: Median age was 36 years [range13-80 years] among 95 deaths due to Dengue. Male gender comprised 60 [63.1%]. Co-morbidities existed in 74 [77.9%] with hypertension in 21 [22.1%] diabetes in 11 [11.58%], liver disease in 9 [9.47%] and ischemic heart disease in 8[8.4%] cases. Patients presented at second day of fever for admission [range 1-8 days] and death occurred at a median of 4 days [range 30 minutes to 23 days]. Hospital stay was for less than a week for seventy nine [83.2%] patients and 16 [16.8%] were admitted for more than 7 days, Critical care was required in 67[71%]. Severe hepatitis occurred in 41 [43.1%], acute renal impairment occurred in 32 [33.7%] and disseminated intravascular coagulation in 16 [16.8%]. Deaths were due to prolonged shock 49 [51.5%] fluid overload 46 [48.4%] and massive bleeding 18[19%] leading to organ failure

Conclusion: Decompensated shock complicated by either massive plasma leakage, frank bleeding, multi organ failure or deranged clotting profile results in enhanced mortality in Dengue infection. Co-morbidities especially Diabetes are poor prognostic factors in predicting Dengue mortality

Rectal misoprostol versus intravenous oxytocin in the active management of the third stage of Labour

Objectives: Postpartum hemorrhage [PPH] at third stage of labour may cause maternal morbidity. This study compared efficacy of rectal misoprostol and intravenous oxytocin in the active management of third stage of labour

Methods: The study involved 188 subjects in two groups. Group A was given Misoprostol 800microg rectally and group B was given oxytocin 10IU intravenously at the delivery of anterior shoulder of the baby

Results: The amount of blood loss was >500 ml in 12 patients in which 8 [8.5% from group A] were from group A and 4 [4.3%] were from group B. The frequency of PPH was statistically same in both study groups [P value = 0.62]. The mean change of Hb in group A was 2.71 +/- 0.15 g/dl and in group B 9.10 +/- 1.23 g/dl

Conclusion: Results suggested that I/V oxytocin is more effective compared to rectal misoprostol for the active management of the third stage of labour