Leucocytosis and early organ involvement as risk factors of mortality in adults with dengue fever.

The clinical profile and risk factors for mortality in dengue fever have evolved over the years. The all-cause mortality in admitted dengue patients is around 6%. We aimed to evaluate the recent change in trends of the clinical characteristics and risk factors for in-hospital mortality in adults with dengue fever. This is a retrospective study on adults with confirmed dengue fever admitted in a medical unit of a tertiary care center in North India. Medical records of confirmed dengue fever patients admitted between January 2011, and December 2016 were reviewed. Chi-squared tests with Bonferroni correction for multiple testing were used to identify risk factors for mortality. 232 records were included, of which 66.8% were males. The mean age was 31.6 ± 14 years. There were 17 deaths with an all-cause mortality rate of 7.3% with 76.5% being classified as severe dengue at admission. Among the 17 mortality cases, dyspnea (47%), tachypnea (86.7%), leucocytosis (58.8%), raised urea (80%), and elevated serum creatinine (52.9%) at presentation were significantly associated with mortality (p < 0.001). Shock at any time during the hospital stay (58.8%) was also found to be significantly associated with mortality (p < 0.001). We found that dyspnea, tachypnea, acute kidney injury, and leucocytosis at presentation was significantly associated with in-hospital mortality. Based on our results, we recommend aggressive management of patients with severe dengue and those with mild/moderate disease with the above risk factors.

Pulmonary tuberculosis presenting as acute respiratory distress syndrome.

Pulmonary tuberculosis (TB) may present in the form of parenchymal disease or extraparenchymal disease. Patients with TB as a primary cause of respiratory failure requiring mechanical ventilation have been reported to have mortality rates ranging between 47% and 80%. However, acute respiratory distress syndrome (ARDS) as a presentation of TB is rarely reported. We describe two cases of immunocompetent women presenting with ARDS. They were initially worked up for viral aetiologies in view of the ongoing COVID-19 pandemic but were later diagnosed to have microbiologically proven parenchymal pulmonary TB. One of our patients succumbed to nosocomial pneumonia, while the other was discharged to follow-up.

Role of routine use of ultrasonographic guidance for performing lumbar punctures.

PURPOSE OF STUDY: Ultrasound (US) for lumbar puncture has seen the most success in obese patients and in patients with difficult to palpate landmarks. We aimed to elucidate the advantage of the use of routine US for performing lumbar punctures over the traditional landmark method. STUDY DESIGN: This was a prospective study with consecutive sampling with a sample size of convenience. Three residents were chosen to perform the lumbar punctures after a training session. Patients were assigned to either the US group or the landmark group. The outcomes studied were number of attempts at needle insertion, patient and physician anxiety, pain experienced, time to procedure, number of traumatic attempts and the difficulties faced during the procedure. RESULTS: A total of 77 patients were included in this study, of which 36 patients (46.8%) underwent landmark-based lumbar puncture and 41 (53.2%) underwent US-guided lumbar puncture. There was no statistically significant difference between the two groups among the following characteristics: number of attempts to a successful procedure, number of traumatic punctures, procedure time, preprocedure anxiety of the participants and physicians and pain score rating of the procedure. CONCLUSION: There was no significant difference between the landmark method and US-guided method for performing lumbar puncture in the number of successful attempts, number of traumatic punctures, procedure time and pain during the procedure. Further studies are required to elucidate the advantage of the use of ultrasonography in subsets of the population such as the low body mass index population.

Study of normal volumetric variation in the putamen with age and sex using magnetic resonance imaging.

Putamen volume is seen to alter in neurological and psychiatric disorders like Parkinson's disease, depression, schizophrenia, Alzheimer's disease, and in individuals treated with antipsychotics. To establish a trend in volume changes in pathologic states, studies on factors influencing normal variation in a given population become essential. This study aimed to evaluate the normal variations in putamen volume in the Indian population and correlate them with the effects of age and sex. Bilateral symmetry was also evaluated. The study included MR images of 98 individuals aged 10-87 years. Axial sections of T2-weighted spin echo sequences were used to estimate putamen volume. The putamen was delineated manually and its volume was estimated using Cavalieri's principle. Linear regression and paired t-test were used to analyze data. Bilateral putamen volume reduced with age in both sexes. This was statistically significant (P < 0.05) except for the left putamen volume in males. There was no significant age-adjusted effect of sex on putamen volume in both hemispheres (P > 0.05). Age and sex interaction was not found to be statistically significant. Hemispherical asymmetry was not established as the difference between the right and left putamen volume did not reach statistical significance in both males and females (P > 0.05). In conclusion, this study demonstrated an age related decline in the volumes of both putamen in males and females. The rate of volume reduction was not affected by sex. The study failed to establish a significant sex difference and hemispherical asymmetry in putamen volume. Clin. Anat. 30:461-466, 2017. © 2017 Wiley Periodicals, Inc.