Predictive Analysis of Gallbladder Wall Thickness as a Marker for Bleeding Risk and Need for Transfusion in Dengue Patients.

Objective:The objective of the following study is to determine the use of ultrasound as an important adjunct to clinical and laboratory profile in diagnosing dengue fever and in predicting the severity of the disease by correlating imaging features with platelet count. The variation in sonographic features seen in patients from different age groups was also studied.Materials and Methods:This is a retrospective study. 96 patients who were serologically diagnosed as having dengue fever between April and August 2012 were referred for ultrasound scanning of the abdomen and thorax and the imaging findings were analyzed.Results:Out of 96 sero-positive dengue cases, 64 (66.7%) patients showed edematous gallbladder (GB) wall thickening, 62 (64.5%) patients showed ascites, 48 (50%) patients had pleural effusion, 17 (17.7%) patients had hepatomegaly, 16 (16.7%) patients had splenomegaly and in 17 (17.7%) patients ultrasound findings were normal. Edematous GB wall thickening, ascites and pleural effusion were the most common combination of findings in all age groups. Edematous GB wall thickening was seen in 97.8% of patients with platelet count of less than 40,000 along with ascites (86.9%) and pleural effusion (58.6%). In patients with platelet count between 40,000 and 80,000 ascites was more common than edematous GB wall thickening. Significantly no abnormal sonographic finding was detected in patient with platelet count more than 150,000.Conclusion:Sonographic features of thickened GB wall, pleural effusion (bilateral or right side), ascites, hepatomegaly and splenomegaly should strongly favor the diagnosis of dengue fever in patients presenting with fever and associated symptoms, particularly during an epidemic. The degree of thrombocytopenia showed a significant direct relationship to abnormal ultrasound features.

INTRODUCTION: Dengue infection is recognized worldwide as the most important arthropod vector borne disease in the last four decades and a major public health problem, assuming epidemic proportion in urban areas of tropical countries in South east Asia. It is caused by one of the four dengue virus serotypes DEN-1, DEN-2, DEN-3 and DEN-4. Aedes aegypti is the main mosquito vector. Dengue infection can be asymptomatic or can cause two clinical entities: dengue fever (DF) and dengue haemorrhagic fever/ dengue shock syndrome (DHF/DSS). Dengue is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome. Thrombocytopenia may be frequently observed in DF, but is a constant feature and one of the diagnostic criteria of DHF/DSS. There is a need to identify various clinical presentations, complications and treatment outcome of Dengue patients. Hence, this study was undertaken to ascertain all the above mentioned clinical parameters in proven dengue patients who were admitted to this tertiary care hospital, with a special emphasis on correlation between platelet count and bleeding manifestations. MATERIALS AND METHODS: This cross sectional study was conducted for a period of 2 years from October 2010 to September 2012. 100 hospitalized and confirmed dengue cases were included and they were classified as having dengue fever (DF), dengue hemorrhagic fever (DHF)/ dengue shock syndrome (DSS) as per WHO criteria. A detailed clinical evaluation with appropriate laboratory investigations were done. All the patients were treated and followed up with clinical assessment and serial platelet counts. Data was analyzed with suitable software and appropriate statistical methods. RESULTS: There were 57 males and 43 females, with majority in the age group 21 to 40 years. Fever was the most common symptom present in all the patients (100%), followed by vomiting (24%), myalgia (23%), headache (21%), and pain abdomen (20%). Bleeding manifestation were noted in 18 patients (18%), out of which 5 patients had platelet count 61,000 platelet count. There was no correlation between platelet count and bleeding manifestations (p value > 0.05). CONCLUSION: Dengue remains an important differential diagnosis for all acute fevers in India. Dengue should be suspected even in patients without classical presentation of dengue as many Dengue patients present with atypical manifestations. Due to lack of direct correlation between low platelet count and bleeding tendencies, low platelet count alone is not an indication for platelet transfusion and a close monitoring for bleeding manifestation and hemodynamic stability with reasonable judgment should be exercised in deciding the need for transfusion in Dengue patients. Prevention of uncomplicated Dengue fever going on for DHS and DSS

Admission platelet (PLT) counts are known to be associated with all-cause mortality for seriously injured patients admitted to a trauma center. The course of subsequent PLT counts, their implications, and the effects of PLT therapy are less well known. Trauma center patients who were directly admitted from the scene of injury, received 1 or more units of uncrossmatched red blood cells in the first hour of care, survived for at least 15 minutes, and had a PLT count measured in the first hour were analyzed for the association of their admission and subsequent PLT counts in the first 24 hours with injury severity and hemorrhagic and central nervous system (CNS) causes of in-hospital mortality. Over an 8.25-year period, 1292 of 45,849 direct trauma admissions met entry criteria. Admission PLT counts averaged 228×10(9) ±90×10(9) /L and decreased by 104×10(9) /L by the second hour and 1×10(9) /L each hour thereafter. The admission count was not related to time to admission. Each 1-point increase in the injury severity score was associated with a 1×10(9) /L decrease in the PLT count at all times in the first 24 hours of care. Admission PLT counts were strongly associated with hemorrhagic and CNS injury mortality and subsequent PLT counts. Effects of PLT therapy could not be ascertained. Admission PLT counts in critically injured trauma patients are usually normal, decreasing after admission. Low PLT counts at admission and during the course of trauma care are strongly associated with mortality.

Objective: To signify the ultrasonographic findings as an adjunct to serological diagnosis of dengue fever and to correlate ultrasound findings of dengue patients from the disease outbreak in 2019 and 2022 Pakistan with serological parameters such as platelet count, WBC and hematocrit. Study Design: Prospective longitudinal study. Place and Duration of Study: Radiology Department, Federal Government Polyclinic (PGMI), Islamabad, Pakistan from Jan2019 to Dec 2022. Methodology: All patients referred to the Radiology Department for an Ultrasound Abdomen, who were admitted to the Hospital Isolation Unit and were found to have anti-dengue serology, were included in the data. Ultrasonographic findings of dengue patients from the disease outbreak in 2019 and 2022 along with serological parameters such as platelet count, WBC and Hematocrit were assessed. Results: Out of 343 diagnosed dengue fever patients from the 2019 and 2022 outbreaks Pakistan, the majority (n=176; 51.3%) patients had thickening of the gall bladder wall finding, followed by hepatomegaly (n=100; 29.2%), ascites (n=94;27.4%), pleural effusion (n=84; 24.5%), splenomegaly (n=47; 13.7%) and perinephric fluid (n=8;2.3%). Thickness of the gallbladder (n=90; 68.2%) wall was most common in cases with platelet counts <40,000. There was a statistically significant difference found with reduced platelet count and gall bladder wall thickening (p-value < 0.001), pleural effusion (p-value=0.008) and ascites (p-value < 0.001). In 2019, Dengue fever was more severe than in 2022 in patients. Conclusion: The ultrasonographic findings and their co-relation with serological parameters identify USG as a competitive diagnostic procedure for dengue fever

IntroductionDengue fever is a mosquito-borne viral disease spread by the bite of the Aedes aegypti mosquito. Dengue epidemics have contributed to a great economic burden, especially in South-East Asia. This study aimed to determine gall bladder wall thickness (GBWT) in patients with dengue fever, assess its sensitivity and specificity to identify dengue hemorrhagic fever, and also compare gall bladder wall thickening (GWBT) with platelets, hematocrit, and leucocyte count.Materials and methodsThis prospective observational study was conducted in the dengue ward of Benazir Bhutto Hospital, Rawalpindi, Pakistan, from September 2019 to January 2020, i.e., four months. Patients admitted to the dengue ward diagnosed as seropositive and provided consent were enrolled into the study. Laboratory investigations (blood complete picture, liver function tests, renal function tests) were collected and recorded. Ultrasonography was performed on admission and subsequently during a hospital stay. Patients were divided into two groups: those with gall bladder wall thickness ≤ 3mm and ˃3mm. All data were entered and analyzed on SPSS version 24 (IBM Inc., Armonk, USA).ResultsOut of 180 patients, 122 (67.8%) were male, and 58 (32.2%) female. The mean age was 33 ± 13 years. One hundred and six patients (58.9%) were diagnosed with dengue fever, 68 (37.8%) - dengue hemorrhagic fever, and six (3.3%) - dengue shock syndrome. The most common finding was gall bladder wall thickness ˃3mm (69/180; 38.3%) followed by ascites (38.1%). Sixty-two patients out of 69 (89.9%) with GBWT ˃3mm were managed as dengue hemorrhagic fever (p=0.000). Alanine transaminase (ALT), platelet, and total leukocyte count (TLC) were associated positively with an edematous gall bladder wall (p<0.005). The mean gall bladder wall thickness for dengue hemorrhagic fever was 6.4mm ± 2.5 mm. A GBWT value of 3.5mm was found to have 94.6% specificity and 91.2% sensitivity.ConclusionGall bladder wall edema is strongly correlated with dengue hemorrhagic fever. Hence it should be assessed in all patients with dengue fever.

Dengue fever is the most prevalent mosquito-borne viral disease in humans. Platelet indices (PIs) are given by the cell counters but are often not reported which is possibly due to under-recognition of the utility of these parameters. This study aimed to compare PIs in patients with dengue fever to assess their role in the outcome such as hospital stay and platelet transfusion requirements. Prospective observational study in a tertiary care center, Thrissur, Kerala. A group of 250 dengue patients was studied over a period of 18 months. The platelet parameters (platelet count, mean platelet volume [MPV], platelet distribution width [PDW], platelet large cell ratio [PLCR], plateletcrit [PCT] and immature platelet fraction [IPF]) were measured with Sysmex XN-1000 and followed up every 24 h. The clinical features, duration of hospital stay and platelet transfusion requirements details were collected. Independent t-test, Chi-square test, Karl Pearson correlation coefficient. A total of sample size was 250. The study showed normal PDW and MPV, low platelet count and PCT, and high PLCR and IPF in dengue patients. There were significant differences in PIs (lower platelet count and PCT, higher MPV, PDW, PLCR, and IPF) in comparison between dengue patients based on platelet transfusion. PIs may act as a predictive tool in the diagnosis and predicting outcomes in dengue fever. Low platelet count and PCT, high PDW, MPV, PLCR, and IPF in transfused dengue patients were found to be statistically significant. Clinicians need to be sensitized about the utility and limitations of these indices and rationalize the need for red cell and platelet transfusions in dengue.

Introduction Gallbladder (GB) wall thickening is a relatively common finding on imaging. While there are clear recommendations for the management of gallstones, GB wall thickening presents a significant challenge. Despite advances in radiological as well as endoscopic techniques, the ability to characterize GB wall thickening is still limited. Areas covered This review summarizes the currently available literature on various imaging investigations to characterize GB wall thickening. This review also summarizes the differences between benign and malignant GB wall thickening based on available imaging modalities. Transabdominal ultrasonography is the first-line investigation for evaluation of GB wall thickening. However, further characterization requires additional imaging tests. Magnetic resonance imaging (MRI) with the use of gadolinium and diffusion-weighted sequence is the preferred modality for GB wall characterization. Expert opinion The accurate characterization of GB wall thickening is a challenging task. The available imaging criteria allow differentiation of benign and malignant GB wall thickening with moderate accuracy. The advanced imaging techniques, including contrast enhanced ultrasound, contrast-enhanced endoscopic ultrasound, and shear wave elastography, continue to evolve. There is a need for a well-designed reporting system for GB wall thickening to ensure uniformity of reporting of imaging tests, especially in regions with a high prevalence of GB cancer.

Background: Dengue fever, a mosquito-borne viral infection holds pathophysiology in form of the alteration of hematological parameters, particularly platelet count and hematocrit levels, which are indicators of disease severity. Among the radiological workup, gallbladder wall thickening is a notable ultrasonographic finding in dengue patients. Objective was to determine the correlation of gall bladder wall thickness with serum platelets count and hematocrit in dengue NSI positive patients. Methods: A total of 250 enrolled patients underwent a clinical assessment that included measuring gallbladder wall thickness via ultrasonography by trained radiologists, determining serum platelet count using standard hematology analyzers, and assessing hematocrit levels with standard laboratory techniques. These measurements were taken at consistent intervals, such as on admission and on days 3 and 5. An abdominal ultrasound was conducted by a single physician using portable bedside equipment, and all other clinical and laboratory data were obtained from the patients' electronic records. Results: The mean age of the patients was 49.52±8.50 years. Gallbladder wall thickness was less than 3 mm in 50.9%, between 4-6 mm in 46.4%, and 7 mm or more in 2.7%. A significant inverse correlation was found between gallbladder wall thickness and platelet count (ρ = -0.861, p = 0.000) and a strong positive correlation with hematocrit levels (ρ = 0.873, p = 0.000). Conclusion: The present study concluded that evaluation of gallbladder wall thickness is an important step when performed in conjugation with serum platelets count and hematocrit in dengue fever to predict the disease severity and thus aids in the management and improving the outcome in dengue prone areas.

Dengue virus is the most prevalent arthropod-borne viral disease in humans. Severe dengue, defined by hemorrhagic fever and dengue shock syndrome, can develop quickly in people who have warning indications such as abdominal pain, mucosal bleeding, and a significant decrease in platelet count. Laboratory markers such as hematocrit, platelet count, liver enzymes, and coagulation tests are critical for early diagnosis and prognosis. This retrospective study was carried out from January 2023 to December 2024 at a super-specialty tertiary care hospital. There were 283 adult patients with dengue with warning signs, who were categorized into 102 with platelet transfusion and 181 with no platelet transfusion. Data on patient demographics, clinical history, laboratory values, and radiological findings were systematically obtained from hospital records at the time of admission. Laboratory parameters such as white blood cell (OR = 2.137), hemoglobin (OR = 2.15), aPTT (OR = 5.815), AST2/ALT (OR = 2.431), platelet count (OR = 26.261) and NS1 (OR = 4.279) were found to be significantly associated (p < 0.01) with platelet transfusion. Similarly, an increased prothrombin time (OR = 2.432) contributed to prolonged hospital stays and the presence of ascites (OR = 5.059), gallbladder wall thickening (OR = 4.212), and pleural effusion (OR = 2.917), contributing to the severity of the dengue infection. These significant laboratory markers help with identifying patients with dengue who may develop severe dengue, requiring platelet transfusion, thereby prioritizing patient care and enabling the implementation of targeted interventions.

ObjectivesTo evaluate the association between ultrasound assessment of gallbladder wall thickness (GBWT) among severe dengue patients and dengue patients with warning signs to their clinical outcomes.MethodsA prospective, cross-sectional study involving adult dengue patients presented to our emergency department between March until September 2018. The patients were classified based on WHO classification. A gallbladder wall scan was performed on all patients.ResultsA total of 44 patients were enrolled into the study; majority of the patients with GBWT had severe dengue, significantly more than the dengue patients with warning signs (90.5% sensitivity; 69.6% specificity). The sensitivity of GBWT in determining admission to critical care areas or general ward was 100% with a specificity of 62.1%. Our analysis showed that the two variables significant in determining the severity of dengue were age (p = 0.045) and GBWT (p < 0.001). Both factors together gave 81.0% sensitivity and 78.3% specificity in predicting patients for severe dengue. The receiver operator characteristic curve revealed that using variable GBWT status can discriminate 87.1% (95%CI 66.3, 93.7%) of having severe dengue or dengue with warning signs.ConclusionThe finding of GBWT when consolidated with other clinical parameters may assist clinicians to perform risk stratification in the emergency department and become another adjunct to the assessment of severe dengue.

Effect of the Coronavirus 2019 Pandemic on Outcomes for Patients Admitted With Gastrointestinal Bleeding in New York City

Introduction: Significant increase in plasma leakage is characteristic of severe dengue. This results in collection of fluid in serous cavities. Gall bladder wall thickening (GBWT) often precedes the development of pleural effusion and ascites. Early detection of plasma leakage and management is shown to reduce mortality in dengue illness. Ultrasonography is a point of care investigation to identify GBWT. The aim of this study was to determine the cut-off value of GBWT to predict severe dengue in the early phase of the illness. Methods: This was a prospective study done on 310 children with dengue illness. Abdomen and chest ultrasound was done in all these children between third and sixth day of illness. GBWT of more than 3.5 mm was taken as a thickened gall bladder wall. Maximum severity of the illness was considered for categorising the severity of dengue. Results: Out of 310 children, 160 (51.6%) were categorized as dengue fever, 91 (29.4%) as dengue with warning signs and 59 (19%) as severe dengue. The incidence of thickened gall bladder wall was 27.5% in DF (Dengue fever), 68% in DF with warning signs and 96.6% in severe dengue. The odds of finding thickened gall bladder wall in severe dengue are 3.5 times that of dengue fever. GBWT increases as the severity of the illness increases. GBWT of 5 mm has sensitivity of 93.7% and specificity of 70% to predict progress to severe dengue. There was a fair correlation of 46% between thickened gall bladder wall and thrombocytopenia. Gall bladder wall thickness of 2.5 mm had sensitivity of 86.3% and specificity of 80% for ascites. GBWT of 3.5 mm had a sensitivity of 77.6% and specificity of 85% for pleural effusion. Conclusions: GBWT assessment by ultrasonography in early phase of illness can be used as a point of care modality to predict severe dengue. The sensitivity and specificity to predict the progression to severe dengue is 93.7% &amp; 70% respectively for the cut-off value of five mm of GBWT.

The British Journal of Haematology publishes original research papers in clinical, laboratory and experimental haematology. The Journal also features annotations, reviews, short reports, images in haematology and Letters to the Editor.

We asked whether patients >50 years of age with acute traumatic brain injury (TBI) present with lower platelet counts and whether lower platelet counts are independently associated with mortality. We combined trauma registry and laboratory data on a retrospective cohort of all patients ≥18 years of age admitted to our Level 1 US regional trauma center 2015-2021 with severe (Head Abbreviated Injury Score [AIS] ≥3), isolated (all other AIS <3) TBI who had a first platelet count within 1 h of arrival. Age and platelet count were assessed continuously and as groups (age 18-50 vs. >50, platelet normals, and at conventional transfusion thresholds). Outcomes such as mean admission platelet counts and in-hospital mortality were assessed categorically and with logistic regression. Of 44,056 patients, 1298 (3%, median age: 52 [IQR 33,68], 76.1% male) met all inclusion criteria with no differences between younger and older age groups for (ISS; 18 [14,26] vs. 17 [14,26], p = .22), New ISS (NISS; 29 [19,50] vs. 28 [17,50], p = .36), or AIS-Head (4 [3,5] vs. 4 [3,5]; p = .87). Patients aged >50 had lower admission platelet counts (219,000 ± 93,000 vs. 242,000 ± 76,000/μL; p < .001) and greater in-hospital mortality (24.5% vs. 15.6%, p < .001) than those 18-50. In multivariable regression, firearms injuries (OR9.08), increasing age (OR1.004), NISS (OR1.007), and AIS-Head (OR1.05), and decreasing admission platelet counts (OR0.998) were independently associated with mortality (p < .001-.041). Platelet transfusion in the first 4 h of care was more frequent among older patients (p < .001). Older patients with TBI had lower admission platelet counts, which were independently associated with greater mortality.

Background: Laparoscopic cholecystectomy (LC) is the gold standard for gallstone diseases. Preoperative ultrasonography findings can have a significant impact on the perioperative and postoperative outcomes. This study aimed to evaluate the influence of preoperative gallbladder (GB) wall thickness, measured by ultrasonography, on the perioperative outcomes of patients undergoing elective LC. Methods: This prospective, cross-sectional study was conducted at a tertiary care center and included 60 patients undergoing LC. Preoperative GB wall thickness was measured via ultrasonography, and patients were stratified into four groups: &lt;2 mm, 2-4 mm, 4-6 mm, and &gt;6 mm. Intraoperative complications, postoperative complications, and the duration of hospital stay were prospectively documented and correlated with GB wall thickness. Statistical analysis was performed using ANOVA and chi-square tests to compare outcomes among the four groups. Results: The mean age was 44±13 years, and 68.3% were female. A GB wall thickness of 2-4 mm was the most common finding (40%), followed by &lt;2 mm (30%). Patients with a thicker GB wall had significantly more intraoperative complications (p=0.001). Thicker GB wall was significantly associated with postoperative bile leak (p=0.007) and wound infection (p=0.041). The mean hospital stay was also significantly longer for patients with a thicker GB wall (p=0.001). Conclusions: Preoperative GB wall thickness on ultrasonography is a strong predictor of operative difficulty, postoperative complications, and prolonged hospitalization following LC. Incorporating this simple, non-invasive measure into routine preoperative assessment may improve risk stratification and surgical planning.