Diagnosis Of Dengue Hemorrhagic Fever Research Articles

Dengue Hemorrhagic Fever Presenting with Acute Abdomen in a Non- Government Tertiary Care Hospital in Bangladesh

A 60-year-old diabetic and hypertensive post-menopausal lady, presented at a tertiary care Hospital in Dhaka, Bangladesh with severe abdominal pain in the right middle and lower abdomen, associated with oliguria for 1 day. She also gave history of having high grade fever and headache for 3 days, which subsided 2 days ago. On examination, she was afebrile, mildly dehydrated, tachycardic (PR- 110/min), hypotensive (BP- 90/60 mm Hg), Tourniquet Test was positive. Her abdomen was tense and diffusely tender, especially in the right middle and lower parts, bowel sound was present, no organomegaly or lump was found. S. Lipase was normal, Anti-dengue Antibody IgM and IgG were positive, CBC revealed Hemoglobin – 8.6 gm/dL, Hematocrit was raised- 52%, Platelet count was 16000/ microliter, Stool for OBT was negative, RBS- 16 mmol/L and Urine RME and ketone bodies was negative. A provisional diagnosis of Dengue Hemorrhagic fever with suspected intra- abdominal bleeding was made and she was shifted to ICU.

A Study of Association of Serological Markers and Platelet count in Dengue Patients in GHMC limits, Hyderabad, Telangana

Introduction: Acute viral infections like Dengue which can result in Dengue Hemorrhagic fever (DHF) & DengueShock Syndrome (DSS) are potentially lethal. The measurement of released NS1 protein, IgM & IgG is a noveltechnique for identifying acute dengue infection. Platelet count is the only Non-dengue parameter that can supportthe diagnosis of DHF& DSS.1AIM: This study was done to evaluate the association of Platelet count and Dengue parameters singly positive andwhen combined positive.Materials and Methods: This was a Cross- Sectional prospective study conducted at Departments of Microbiology &Pathology at Telangana Diagnostics, Hyderabad which is a NABL accredited Central Laboratory run by Governmentof Telangana from Febraury 2022 to January 2023.All clinically suspected cases of Dengue reported in Outpatientdepartments of Primary Health Centers (PHCs), Community Health Centers (CHCs), Area Hospitals & DistrictHospital, Under GHMC limits Hyderabad were included in the study from February 2022 to January 2023Results: Out of 1100 samples received from clinically suspected cases of Dengue, 516 (46.9%) samples werepositive for Dengue, and out which 109 (21.12%) cases showed platelet count below 1.5 lakhs/cumm. Denguecases with positive NS1 and IgM were consistently associated with Thrombocytopenia in comparison with otherserological parameters. The Chi-Square test and statistical software Epi info and MS Excel was used to find out thestatistical significance.Conclusion: Detection of dengue specific serological parameters along with platelet count in diagnosis of Denguehelps in early diagnosis and prevent complications like Dengue Hemorrhagic fever & Dengue shock syndromethere by reducing mortality and morbidity.

The implementation of digital application in reducing Dengue Hemorrhagic Fever (DHF) infection rate from an economic loss perspective as an effort to achieve the Sustainable Development Goals

Background: Dengue Hemorrhagic Fever (DHF) is a disease caused by the dengue virus transmitted through the Aedes aegypti mosquito and is most commonly found in tropical regions. In contemporary society, there is significant emphasis on infectious diseases. DHF is a tropical disease that falls under the third indicator of the Sustainable Development Goals (SDGs). DHF poses a significant global public health problem. Currently, its prevalence is spread across more than 100 countries worldwide. Over three decades, the severity of DHF has shown a significant increase across the Southeast Asian region. In 2021, Indonesia recorded a total of 73,518 DHF cases with 705 fatalities. In 2022, there were 143,266 reported cases resulting in 1,237 deaths. As of March 2023, there have been a total of 17,434 reported cases with 141 fatalities. These DHF case incidence figures indicate a considerable increase.Purpose: To reduce DHF cases in South Tangerang City by creating an innovative digital application which is called “Pakar” from an economic loss perspective.Method: This research adopts a mixed-method approach with exploratory research. The research begins with a qualitative phase to design the application, followed by a quantitative phase to assess the effectiveness of the developed application. The study commences with a Focus Group Discussion (FGD) involving various stakeholders, including the South Tangerang City Health Office, public health centers, and community health workers. Subsequently, the application is developed and tested in selected pilot areas as an initial project. Further testing is conducted using a one-group pre-test post-test design. The experimental procedure includes a pre-test as an initial observation, followed by the intervention, and concludes with a post-test as a final observation.Results: During the pre-test, it was observed that DHF patients had a moderate level of knowledge, with a cumulative percentage of 46%. In contrast, the majority of respondents in the post-test had a high level of knowledge regarding DHF diagnosis, with a percentage of 76%. The paired t-test showed a t-value of -6.306 and the corresponding probability or significance value of 0.000 (p < 0.005).Conclusion: The expert system application, as an innovative approach for DHF mitigation and the experimental assessment of economic impact, is effective as indicated by the pre-post test. Furthermore, it is crucial to consider the economic impact of the costs incurred by DHF patients by placing greater emphasis on improving environmental cleanliness efforts.

Correlation Of Positive IgM or IgG RDT (Rapid Diagnostic Test) Results with CRP (C-Reactive Protein) Levels in Dengue Hemorrhagic Fever Patients

Background: Laboratory diagnosis of Dengue Hemorrhagic Fever includes the IgM & IgG RDT (Rapid Diagnostic Test) examination which differentiates primary and secondary dengue infection. The presence of inflammation in the body caused by the dengue virus needs to be examined for C-Reactive Protein. Methods: This research is an analytical observational study with a cross sectional approach. Thesample used is a plasma sample of a patient diagnosed with DHF with a positive IgM or IgG RDT result. Results: Positive IgM RDT results were 6 people (17%) and positive IgG were 30 people (83%). The results of a qualitative CRP study were 24 people (67%) with positive CRP levels. Semi-quantitative CRP average level for positive IgG was29.33. The results of the Spearman's Rank statistical test obtained a value of p = 0.003 <0.05 which showed a significant result. Conclusion:Clinically it shows that the more positive IgM or IgG RDT results obtained, the higher the CRP level which indicates the severity/inflammation that is formed in the body.

Prediction of conservative epitopes in the NS1 sequences of all four dengue virus serotypes

The Dengue virus, transmitted by Aedes aegypti mosquitoes, causes dengue fever, a life-threatening illness. NS1 (Nonstructural Protein 1) has been widely used as a biomarker for detecting dengue due to its early occurrence, high sensitivity, and specificity. The main objective of this study was to design an epitope-rich peptide capable of identifying all four dengue serotypes using homology modeling. Homology protein modeling, a computational approach, predicts the 3D structure of a protein by comparing its sequence to a known template. To achieve this goal, various bioinformatics tools, such as Blast/NCBI, BepiPred, Discotope 2.0, and HADDOCK, were utilized. As a result, there were 18 consensus sequences for the four Dengue serotypes from amino acid 12 to 344. However, the eight of them have shown the most highly scoring conservative sequence segments in BepiBred, Antigenicity, Beta turn, Surface accessibility, Flexibility, and Hydrophilicity. In the results of predicting epitopes, three conservative segments predicted to be the best antigens were selected. Combining the resulting parts, two potential NS1 peptides, containing 149 amino acids from positions 112 to 260, were identified and characterized in all four DENV strains. It is the sequence segment that will be selected for creating materials such as recombinant antigens and monoclonal antibodies for the diagnosis of dengue hemorrhagic fever in the next study.

ANALISIS ASUHAN KEPERAWATAN MELALUI INTERVENSI WATER TEPID SPONGE PADA ANAK DENGAN HIPERTERMIA DI RSU UKI JAKARTA

Background: Dengue Hemorrhagic Fever (DHF) is an acute infectious disease caused by the Dengue virus which enters the body through the bite of the Aedes aegypti mosquito. The nursing problem that arises in children with DHF is hyperthermia. Hyperthermia is an increase in body temperature to be higher than usual. The child's normal body temperature is at 37.5oC, if the body shows this figure it indicates a fever caused by infection. The negative impact that can be caused if a child's fever is not handled properly and further treatment will cause dehydration due to increased evaporation of fluids so that the body can lack fluids. If fever is not treated quickly and appropriately, fever can endanger the safety of the child so that it can cause other complications (seizures and loss of consciousness). One of the nursing actions that can be performed on children with hyperthermia is a water tepid sponge. Water tepid sponge is an act of warm compresses with the technique of wiping given to patients who have high fever to reduce or reduce body temperature. Objective: To analyze nursing care through water tepid sponge intervention with ineffective hyperthermia problems with a children diagnosis of DHF. Result: The results of the nursing evaluation on the main nursing problem of hyperthermia based on progress notes, after the intervention of the water tepid sponge on children. A and children. D for 3 days with a frequency of 1 time per day obtained data on the third day of nursing action, namely that both clients experienced a decrease in body temperature. Body temperature children. A 38oC, after being given water tepid sponge therapy for 3 days it decreased to 36.7oC. body temperature children. D 39oC, after being given water tepid sponge therapy for 3 days it dropped to 37oC. Conclusion: Giving water tepid sponge intervention can overcome the problem of nursing hyperthermia as evidenced by a decrease in body temperature in children.
 Keywords: DHF, hyperthermia, water tepid sponge

REVIEW OF THE ACCURACY OF THE DIAGNOSIS CODE OF DENGUE HAEMORRHAGIC FEVER IN MEDICAL RECORDS IN RSUD dr. RASIDIN PADANG

ABSTRACT
 
 The accuracy of the code is needed so that the information resulting from the diagnosis and action is accurate. However, the authors found that at RSUD dr.Rasidin Padang there were still incorrect codes. This is because the diagnosis of Dengue Haemorrhagic Fever is not correct in giving the code according to the ICD-10. The purpose of this study was to determine the accuracy of the diagnostic code for dengue haemorrhagic fever in medical records at dr.racidin. This research method used is quantitative with a descriptive approach. This research was conducted from February to May 2022. The number of samples was 59 medical records using the total sampling method, and the tool used was a checklist table with univariate analysis. The results of this study were obtained from 59 medical records, there were 37 (62.7%) medical records with inappropriate codes, and a small proportion of 10 (16.9%) medical records that were not clearly written, and there were 39 incomplete diagnosis writings. (66.1%) this was due to errors in determining the diagnosis code, doctors' writings that were difficult to read, incomplete completeness, non-specific written diagnoses based on ICD-10, and the use of abbreviations that were not standardized in hospitals. Therefore, researchers suggest that coders should pay attention to the rules and procedures for coding a diagnosis based on ICD-10.
 Keywords: Coding Accuracy, Clarity, Completeness

Leucocytes, thrombocytes and immature platelets in patients with dengue hemorrhagic fever

Diagnosis of Dengue Hemorrhagic Fever (DHF) is based on clinical and supporting examinations, including leukocytes and platelets examinations and antigen and antibody tests for the dengue virus. Examining leucocytes, thrombocytes, and immature platelets is a routine protocol in DHF patients. Leucocytes, thrombocytes, and immature platelets in dengue hemorrhagic fever have their characteristics and roles in relation to the disease severity. Prompt and early diagnosis will reduce the risk of disease severity. This review described the characteristics and role of leucocytes, thrombocytes, and immature platelets in dengue hemorrhagic fever.

Development of a novel diagnostic kit candidate to detect dengue antibody, using IgY and protein a positive Staphylococcus aureus

Early diagnosis of dengue hemorrhagic fever (DHF) is very important in determining further management. Diagnostic kits are intended as relatively faster, easier, and cheaper diagnostic tools. The objectives of this experimental laboratory study was to prepare a diagnostic kit candidate to detect dengue antibody in human serum using co -agglutination methods by utilizing protein A positive Staphylococcus aureus as a carrier to bind Fc immunoglobulin fractions without altering its ability to bind antigen. To enhance the sensitivity and specificity of the diagnostic kit, chicken IgY was used as one of the components. Rabbit immunoglobulin chicken anti-IgY was used as an intermediary connection between protein A positive and Staphylococcus aureus with chicken IgY. Solution A contains Staphylococcus aureus Cowan I and rabbit immunoglobulin chicken anti-IgY serum while Solution B contains anti-dengue chicken serum and dengue antigen. The laboratory experiments produced a formula of A: B = 1~3: 1~3 (v/v), which was then tested to human serum and compared with IgM and IgG ELISA tests as the gold standard. Data on the results of the test were statistically analyzed using chi - square test. Of the 65 qualified samples used, 47.69% resulted in true positive and 41.54% resulted in true negative. Meanwhile, the remaining samples demonstrated false negative (6.15%), positive predictive value (91.2%) and negative predictive value (87.1%). The sensitivity and specificity were 89% and 90%, respectively, with no significant diffe rences (p>0.05). Therefore, co-agglutination method using S. aureus with protein A positive as a carrier can be proposed as a diagnostic kit candidate to detect human serum dengue antibody to screen dengue hemorrhagic fever cases.

Korelasi Temuan Limfosit Plasma Biru dengan Kadar C-Reaktif Protein sebagai Penunjang dalam Diagnosis Demam Berdarah Dengue

Dengue Hemorrhagic Fever diagnosis is supported by examining Blue Plasma Lymphocytes and C-Reactive Protein, in which Blue Plasma Lymphocytes can distinguish Dengue and Non-Dengue infections. At the same time, the C-Reactive Proteins are used to see the presence of inflammation due to infections such as Dengue Virus infection. Objectives: To analyzed the correlation of the number of Blue Plasma Lymphocytes with C-Reactive Protein (CRP) levels in Dengue Hemorrhagic Fever patients. Methods: This study was analytical observational research with a cross-sectional design. The sample used was a patient diagnosed with DHF with a positive Nonstructural protein 1 (NS1) or Rapid Diagnostic Test (RDT) IgG/IgM result. The data was collected and analyzed using Spearman's rank statistical test. Results: The average number of Blue Plasma Lymphocytes in positive samples was 8%, with the number of negative results, namely 4 (13.33%) samples and 26 (86.67%) samples with positive Blue Plasma Lymphocyte results. The average level of C–Reactive Protein in the positive samples was 29.36 mg/L, with results that had normal levels were 11 (36.67%) samples and 19 (63.33%) samples with abnormal C-Reactive Protein levels. Spearman's Rank statistical test results obtained a value of p = 0.000 < 0.05, indicating a correlation between the number of Blue Plasma Lymphocytes and C–Reactive Protein levels in Dengue Hemorrhagic Fever patients. Conclusion: The more Blue Plasma Lymphocytes, the higher C–Reactive Protein levels in Dengue Hemorrhagic Fever.Keywords: blue plasma lymphocytes, C–reactive protein, dengue hemorrhagic fever

Analisis Statistik Asuhan Kesehatan Pasien Rawat Inap Di Rumah Sakit Umum Daerah (RSUD) dr. Rasidin Padang

Medical records are files that contain records and documents including patient identity, examination results, treatment that has been given, as well as actions and other services that have been provided to patients. Data collection was carried out at the Regional General Hospital Dr. Rasidin Padang by recording data on inpatients who were discharged from the period March 01 - March 31, 2018, so that data were obtained as many as 251 patients with 103 beds. Then data processing was carried out using a computer with the Microsoft Excel application program. Furthermore, the data were analyzed and the results of health care statistical processing were presented in the form of tables and Barber Johnson charts. From the grouping of the most common diagnoses based on ICD-10 at the Regional General Hospital Dr. Rasidin Padang for the period March 01 - March 31, 2018, it was found that the most common code was code A91 as many as 21 patients with a diagnosis of Dengue Haemorrhagic Fever (DHF).Grouping the main diagnoses based on bowel movements in ICD-10 resulted in the highest frequency of diagnoses being BAB I (Certain infectious and paracitic diseases) and BAB XV (Pregnancy, chilbirth and pueperium) as many as 12.75% with a total of 32 patients each. The procedure grouping based on ICD-9 CM in RSUD dr. Rasidin Padang for the period March 01 - March 31, 2018 was SC with procedure code
 74.99 as many as 14. Based on the DTD code and its definition, it is known that the most common diagnosis is DTD 032.1 (Dengue hemorrhagic fever) as many as 21 patients. In the RL4a Format table, it is known that the most age group as an inpatient at RSUD dr. Rasidin Padang for the period March 01 - March 31, 2018 is the age group 45 - 64 years as many as 70 patients with female gender as many as 37 patients and male as many as 33 patients, while based on the disposition died as many as 2 and live as many as 249. After data processing, it was obtained that the percentage of BOR at RSUD Dr. Rasidin Padang for the period March 01 - March 31, 2018 had not reached an efficient number because the value obtained was 26.65% or 27%, while the BOR efficiency rate was 60-85%. BTR is 2.44 or 2 times, because the calculation of the BTR number is per year, the BTR efficiency cannot be determined. TI is 9.33 or 9 days. This means that the TI value is not yet at an efficient point, because the TI efficiency value is 1 - 3 days.

Implementation of Forward Chaining for Diagnosis of Dengue Hemorrhagic Fever

Insects in the form of mosquitoes are transmitting vectors of several types of diseases that are quite dangerous and need to be watched out for because they can be deadly, such as dengue fever mosquitoes, malaria, elephantiasis and the like. Patients suffering from mosquito-borne diseases must be treated immediately to find out the type of disease they are suffering from and their treatment solutions. The era of digitalization that is growing rapidly, including in the field of medical science, makes the use of information technology to help improve quality services for the community. The analysis used in this research is using the forward chaining method, as a comparison of the overall process of the problems obtained in the investigation and developed using the waterfall paradigm. Forward chaining is optimized because the disease diagnosis process begins by observing the symptoms experienced by a patient and then continues with a tracing process that results in conclusions about the dengue fever suffered. While the waterfall method is used in the development of this expert system because the method can accommodate all stages of the system starting from the analysis of functional and non-functional system requirements, system design, coding, expert system testing and the last stage is expert system maintenance. The data used in this study used data at the Maos Health Center, Cilacap Regency. Testing is carried out using the black box testing method where the expert system is tested on end-users to determine the level of success and usability of the developed system. The questionnaire was given to 76 respondents with the results of the questionnaire: 91.9% indicating the level of user satisfaction, 89.6% indicating the level of effectiveness and 92.2% indicating the level of efficiency of the expert system. The output of this study is the conclusion of the disease suffered by the patient and the solution for handling it.

Aspek Klinis dan Pemeriksaan Laboratorium untuk Diagnosis Demam Berdarah Dengue

Dengue infection is a viral infection through arthropods that is found throughout the world. This disease is caused by dengue virus which consists of four serotypes and each of these serotypes can cause disease. The pathogenesis of dengue infection, especially the mechanism of dengue hemorrhagic fever (DHF) manifestations is still not clearly understood. The results of laboratory tests on dengue hemorrhagic fever found thrombocytopenia (≤ 100,000/mm3), a 20% increase in hematocrit and a positive Rumple Leed test. Five basic serological tests used to detect antibodies in diagnosing dengue infection are haemagglutination-inhibition (HI), complement fixation (CF), neutralization test (NT), IgM capture enzyme-linked immunosorbent assay (MAC-ELISA), and indirect IgG. ELISA. RT-PCR examination in a number of studies was reported to have successfully detected the dengue virus. This examination has better specificity and sensitivity compared to virus isolation with a fast turn around timeLaboratory tests on dengue infection include hematological, serological and nucleic acid tests that play a role in supporting the rapid and accurate diagnosis of dengue hemorrhagic fever.

HUBUNGAN JUMLAH TROMBOSIT DAN NILAI HEMATOKRIT TERHADAP DERAJAT KEPARAHAN DEMAM BERDARAH DENGUE

Dengue infection is a public health problem in Indonesia in general and North Sumatra in particular, where the cases tend to increase and spread more widely and have the potential to cause outbreaks. Platelets and hematocrit are important parameters in the management of patients with dengue infection. To determine the relationship between platelets counts and hematocrit with the severity of dengue infection, a literature review was conducted by comparing several related journals. The research method used was a Literature Review, using secondary data. Data were collected using documentation techniques. The research journals used were five journals with inclusion criteria for the publicaton date of the last five years, the language used was Indonesian, with the research subjects of patients with a diagnosis of dengue hemorrhagic fever and full text publication. There is a significant relationship between the plateled count and the hemtocrit value with the severity of the dengue infection patients, but there is dengue hemorrhagic fever patients.

Severe hemorrhage in a patient with dengue hemorrhagic fever after insertion of orthodontic mini-implants. A case report

The objective of this paper is to report a clinical case of a patient who after installing an orthodontic mini-implant returned to the dental office seven days later with a severe hemorrhage where it was inserted. Because of the severe character of the hemorrhage, the mini-implant was removed, local compression was performed, medication to control bleeding was given and some lab tests were requested. The patient returned in 24 hours with diagnosis of dengue hemorrhagic fever (DHF). The patient was referred to the specialized hematology service where the diagnosis was confirmed. Past the critical period, a new mini-implant was inserted to continue the orthodontic treatment. It can be concluded from this account that despite the mini-implants being devices of simple installation and easy removal, it is important that the patient's systemic conditions are optimal for their overall effectiveness. Keywords Dengue; Hemorrhage; Orthodontic Anchorage Procedures.

Comparison of results of statistical analysis of health care for inpatients of Islamic hospitals in Padang city in 2019

Background: The success of hospitals in providing services seen from the results of health care statistics, in the form of daily census, day of service, average length of stay (ALOS), bed occupancy rate (BOR), bed turnover rate (BTR), turnover interval (TI), coding disease diagnoses in the of Islam Islamic hospital.Methods: Research uses descriptive method with qualitative approach. Data collection technique used is the observation method that is direct observation of medical records and the method is done by collecting data from the Islamic Hospital in the city of Padang for processing statistical data.Results: During the period of June 1 to June 30, 2014 there were 330 outpatients, 127 bed units in IbnuSina while in Siti Rahmah outpatients were recorded 264 patients with 48 beds. From data it appears that the most patients entering in the city of Padang are Siti Rahmah with the difference in the number of patients 66 patients with 79 beds. And information is obtained that this is influenced by the availability of adequate facilities and services.Conclusions: The highest of patients from the Islamic hospital is Siti Rahmah with a diagnosis of dengue hemorrhagic fever (DHF) (A91), the main diagnosis frequency of chapter XI is 15.45% with the most patients coming from in Padang as many as 194 patients. From the results of statistical data, it can be analyzed that the TLOSis 1357 days and ALOS is 4.11 or 4 days. BOR is 32.94%, The BTR 2.60, TI 7.74 days.

Association of serological parameters and platelet counts in dengue fever: A hospital-based study

BACKGROUND: Dengue fever (DF) is an acute febrile arboviral disease affecting the tropical and subtropical regions of the world. It is known that early and specific diagnosis of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), followed by supportive therapy, reduces morbidity and mortality. Serum levels of secreted NS1 positively correlate with viral titers and have been a useful tool in dengue infection (DI) diagnosis. NS1 detection is reported to be sensitive as well as highly specific. Apart from the dengue-specific parameters, platelet count is the only accessory laboratory test available in the peripheral areas that can support the diagnosis of DHF or DSS. In this study, we tried to correlate the platelet counts and immunochromatography (ICT)-based dengue serology tests. METHODS: A total of 525 serum samples from clinically suspected DF were collected. The samples were tested immediately for NS1, immunoglobulin M (IgM), and IgG by ICT-based tests. Platelet counts of all the cases positive for any of the dengue parameters were noted. The statistical analysis was performed using Z-test. RESULTS: One hundred and nine specimens were tested positive for either one or more of the three markers (NS1, IgM, and IgG). Platelet count CONCLUSION: In the present study, association of thrombocytopenia in dengue parameter-positive cases was found to be highly significant. ICT is the only excellent tool as it is easy, rapid, and easily available in areas with poor resources. Apart from dengue-specific parameters, platelet count is the only accessory laboratory test available in the peripheral areas that can support the diagnosis of DI.

Shock Prognostic Factors in Hospitalized Dengue Hemorrhagic Fever Children

Various clinical manifestations, complex pathogenesis and different virus serotypes in diverse area make us difficult to predict course of disease, even the child admitted in early. Prognostic factors are very important to predict cases progressing to become DSS. Dengue shock syndrome (DSS) occurs in 15.53% of Dengue hemorrhagic fever (DHF) patients with 7.81% mortality rate. Aim: To explore the prognostic factors of shock in hospitalized DHF children regarding the new 2011 WHO dengue virus infection classification guideline. This was a retrospective study using medical records of children age below 18 years old with WHO fulfilled grade 1 and 2 DHF diagnosis from January 2013–December 2016 in Child Health Department of Dr. Cipto Mangunkusumo Hospital, Jakarta. Independent variables were sex, age, nutritional status, secondary dengue infection, leucopenia, abdominal tenderness, gastrointestinal bleeding, hepatomegaly and plasma leakage. Shock was dependent variable. Multivariate analysis was done by using logistic regresion analysis. There were 98 DHF subjects, 5 subjects became DSS during hospitalization. DSS subject characteristics were age of >5 years old, female, malnutrition, abdominal tenderness, hemoconcentration ≥20%, secondary dengue infection, leucocyte ≥5.000 mm3 and thrombocyte <50.000 mm3. Multivaryate analysis showed malnutrition and hepatomegaly were prognosis factors of DSS. Malnutrition and hepatomegaly were prognotic factors of dengue shock syndrome. Clinicians should be more aware with these factors when managed hospitalized DHF patients.

Reversible splenial lesion syndrome associated with dengue fever: a case report

BackgroundDengue virus infection in humans can lead to a wide range of clinical manifestations, from mild fever to potentially fatal dengue shock syndrome. The incidence of dengue fever is on the rise in tropical countries. Due to the increasing incidence of dengue fever worldwide, atypical manifestations of the disease are increasingly reported. In this article we report a patient with dengue haemorrhagic fever who presented with reversible splenial lesion syndrome.Case presentationA 24-year-old Sri Lankan man who presented with fever and confusion was eventually diagnosed to have reversible splenial lesion syndrome based on brain imaging. Clinical, serological and haematological parameters confirmed a diagnosis of dengue haemorrhagic fever. His presentation, assessment, and management are described in this case report.ConclusionReversible splenial lesion syndrome is a condition which is radiologically characterized by reversible lesion in the splenium of the corpus callosum. It is associated with infectious and non-infectious aetiologies. This case report highlights the occurrence of reversible splenial lesion syndrome as a presenting feature of the expanding list of unusual neurological manifestations of dengue infection.

Abstract PD-016: MYOCARDIAL DEPRESSION IN PEDIATRIC DENGUE HEMORRHAGIC FEVER: A PROSPECTIVE OBSERVATIONAL STUDY

Aims & Objectives: In addition to plasma leakage, myocardial depression is thought to contribute in the pathogenesis of Dengue Hemorrhagic Fever (DHF), but its role remains unclear. We aim to compare hemodynamic parameters and myocardial inotropy among 4 grades of DHF. Methods Children (1 month – 18 years old) with DHF admitted to the emergency room (ER) or pediatric intensive care unit (PICU) were recruited between January 2016 and March 2017. Diagnosis of DHF (grade I to IV) was based on World Health Organization (WHO) criteria (2012). We excluded patient who had received fluid resuscitation or inotropes, or had congenital heart disease. Stroke volume index (SVI), Smith-Madigan Inotropy Index (SMII), Cardiac Index (CI), and Systemic Vascular Resistance Index (SVRI) was measured at first admission. Trans-jugular measurement using Ultrasonic Cardiac Output Monitor (USCOM 1A®) was performed by pediatric intensivist or trained-chief resident. Results Two hundred eight out of 230 patients were included. The SVI, CI, and SVRI were comparable among all groups (p=0.40; p=0.75; and p=0.88, respectively). However, most of grade III and IV patients had low SVI (82%), low CI (52%), and high SVRI (63%). The SMII was significantly lower in grade IV (0.96 [0.4–2.2] W/m2) than grade I (1.20 [0.7–1.8] W/m2; p<0.001), grade II (1.10 [0.9–1.8] W/m2; p=0.03), and grade III (1.10 [0.4–2.5] W/m2; p=0.005). Conclusions The most DHF grade III and IV patients were low-output and high-resistance. Myocardial depression was contributed to this condition, especially in DHF grade IV.