Unforeseen complications: a case of dengue shock syndrome presenting with multi-organ dysfunction in a subtropical region.

OVERVIEW: Dengue fever, a viral illness transmitted by the Aedes mosquito, is capable of causing a range of serious complications, including fulminant hepatic failure, renal dysfunction, encephalitis, encephalopathy, neuromuscular and ophthalmic disorders, seizures, and cardiomyopathy. CASE DESCRIPTION: This report details the case of a 30-year-old lactating woman with no notable medical history who presented to the emergency department with symptoms of high-grade fever, altered mental status, and seizures. Upon imaging, bilateral infarcts in the thalami and cerebellar hemispheres were observed, consistent with cerebellitis and dengue encephalitis. PATIENT TREATMENT AND OUTCOME: The patient was admitted to the intensive care unit and received appropriate treatment. Following a critical phase and successful patient stabilization, she was transferred to a high dependency unit for a week before being discharged with recommendations for follow-up care. CONCLUSION: This case illustrates the broad spectrum of complications that can arise as a result of dengue infection and the importance of timely diagnosis and management in improving patient outcomes. Further investigation is required to better understand the mechanisms underlying these complications and to formulate specific guidelines for the prevention and treatment of dengue shock syndrome.

Investigating the interrelatedness of clinical and non-clinical parameters affecting outcomes in COVID-19 patients: a retrospective study.

The COVID-19 pandemic has affected millions globally. Several studies have been carried out to uncover factors affecting the severity of the resulting infection. Available location-specific data concerning the affective demographics as well as clinical aspect of the disease remains limited. In this study, a number of non-clinical as well as the clinical parameters were investigated for their role in adverse progression of the disease in patients admitted to intensive care unit (ICU) in a private tertiary hospital in Peshawar. The prevalence of comorbidities hypertension and diabetes as well as mortality was higher in age group of 70-79 years. Dyspnea was significantly linked to sepsis, invasive ventilation, and mortality; its late presentation, i.e. 15 to 20 days was significantly associated with mortality (p-value < 0.02). Acute kidney injury and acute respiratory distress syndrome were found to be the most strongly associated with sepsis and septic shock. Neither remdesivir nor tocilizumab was effective in preventing the infection-related complications, invasive ventilation, and mortality. Overall, dyspnea was found to be an indicator of the worst progression of the disease. Furthermore, while some parameters were closely linked, others were not.

Nonbacterial thrombotic endocarditis as the initial presentation of prostate cancer- a case report.

Nonbacterial thrombotic endocarditis (NBTE) refers to noninfectious vegetations of the heart valves. It is commonly associated with malignancy and autoimmune diseases like systemic lupus erythematosus, Rheumatoid arthritis. Herein, we present Non-bacterial thrombotic endocarditis and Disseminated intravascular coagulation as the initial manifestations of prostate cancer. A 50-yearold gentleman, known case of hypertension and diabetes, presented with a history of recurrent ischaemic strokes, STEMI and a recent diagnosis of infective endocarditis. He had been taking antibiotics for the past 20 days without any improvement. Negative blood cultures in the presence of vegetations on repeat echocardiography led to a suspicion of NBTE. Laboratory investigations were suggestive of Disseminated intravascular coagulation. CT abdomen and pelvis demonstrated enlarged prostate with enlarged pelvic lymph nodes. Prostate specific antigen was raised at more than 100ng/ml. A bone scan showed extensive metastasis. The patient was started on GnRH analogue and bicalutamide. His Disseminated intravascular coagulation resolved and he was subsequently started on anticoagulants. The valvular lesions diminished without any residual dysfunction.

A typical presentation of dengue fever in a G6PD deficient patient: A case report.

Dengue is a mosquito-borne viral disease that has rapidly spread in the recent years, particularly in South Asia. While haematologic complications, such as cytopenia and bleeding, may occur in severe dengue infection, reports of haemolytic anaemia in dengue fever are scant. We report a patient who developed haemolytic anaemia following dengue fever. A 45 years old gentleman presented with five-day history of fever and was recently diagnosed with dengue fever. He developed jaundice and started vomiting on the third day of his clinical course. His laboratory investigations revealed deranged liver profile, Coombs negative haemolytic anaemia and G6PD deficiency. He was treated conservatively with fluids and blood transfusions. His liver functions and haemolytic anaemia gradually resolved. This case highlights the importance of recognising dengue fever-induced haemolytic anaemia in a G6PD deficient patient by physicians and pathologists, enabling better diagnosis and improved management of this life-threatening condition.

Performance of TUBEX® TF in the diagnosis of enteric fever in private tertiary care Hospital Peshawar, Pakistan.

OBJECTIVE: To evaluate the performance of TUBEX® TF in diagnosing enteric fever. METHODS: The retrospective study was performed at the Northwest General Hospital and Research Centre, Peshawar, Pakistan, and comprised data of all patients who had blood cultures and TUBEX®TF performed as part of their evaluation from April 2011 to November 2015. SPSS 16 was used for data analysis. RESULTS: Of the 970 patients, salmonella typhi was isolated in 43(4.43%), paratyphi in 9(0.93%) and other organisms in 162(16.7%). TUBEX® TF was positive in 18(1.86%) cases and negative in 25(2.58%). Of the culture-negative patients, TUBEX® TF was positive in 35(3.6%) and negative in 136(14%). In cases where no organism was cultured, TUBEX® TF was positive in 4(0.4%) and negative in 752(77.5%). The positive predictive value of TUBEX® TF was 31.58% and the negative predictive value was 97.26%. The sensitivity of TUBEX® TF was 41.86% while specificity was 95.97%. CONCLUSIONS: TUBEX® TF with its low sensitivity and positive predictive value was a poor tool for diagnosing enteric fever.

Purple Urine Bag Syndrome.

Purple Urine Bag Syndrome (PUBS) refers to the purple discoloration of urine and is commonly observed in bed ridden patients with long-term urinary catheters. Although typically benign, the purple discoloration is alarming to both the patients and their attendants. This case report presents an uncommon case of PUBS in a 60-year-old lady with hypertension, type II diabetes, and chronic kidney disease stage 5, who presented to the emergency room with bilateral diabetic foot ulcers of 3 months duration, dry gangrene of ring finger and infected middle and little fingers with abscess over the palmar aspect of right hand of 20 days duration. PUBS is generally associated with alkaline urine as was observed in this patient, although it has also been reported in acidic urine. PUBS has long been documented in association with constipation and so has its association with diarrhea, a finding also observed in this case report.