Gallbladder Wall Edema Research Articles

Role of Ultrasound Imaging in Children with Dengue Fever: A Retrospective Study

Objective: To study ultrasound findings of children with dengue and analyze the possible correlation between ultrasound findings and severity of dengue in children.Methods: This retrospective study, which was conducted over one year, analyzed 50 pediatric dengue patients. Ultrasound findings such as gallbladder wall edema, pleural effusion and ascites were assessed. Cases were categorized into dengue without warning signs, dengue with warning signs, and severe dengue according to the World Health Organization's classification of dengue. Correlation between ultrasound abnormalities, severity of dengue, and thrombocytopenia were analyses. A p-value of less than 0.05 was taken as statistically significant.Results: Of 50 pediatric patients diagnosed with dengue participated in this study, 72% were boys, and 28% were girls with a male-to-female ratio of 1:0.38. Fever was the most frequent symptom (100%), followed by nausea/vomiting (84%) and body ache/myalgia (78%). Ultrasound findings revealed that gallbladder wall edema (48%), pleural effusion (44%), and ascites (50%) were significantly associated with severe dengue and dengue with warning signs (p<0.001). Thrombocytopenia was documented in 58% of cases and correlated significantly with ultrasound abnormalities such as gallbladder wall edema, ascites, and pleural effusion (p=0.0017).Conclusion: Ultrasound findings, such as gallbladder wall edema, pleural effusion and ascites, are significantly associated with severe dengue and dengue with warning signs. These features aid in early identification of high-risk patients.

Disseminated Salmonella Typhi Infection Presenting with Slurred Speech and Encephalopathy: An Unusual Presentation

Abstract: Salmonella enterica serovar Typhi causes systemic infections and typhoid fever in humans, mainly affecting infants and children. It presents mostly with fever, malaise, anorexia, abdominal pain, constipation, and/or diarrhoea. Complications of the disease include intestinal perforation and haemorrhage. However, sometimes extra-intestinal complications are also reported, which rarely include encephalopathy. This report presents a case of a 28-year-old male who presented with somnolence and later developed slurred speech. A week before his current admission, he was admitted with abdominal pain and underwent a laparoscopic appendectomy, and was discharged uneventfully. Now after eight days he presented with somnolence. His neurological examination was otherwise unremarkable. Imaging studies helped to rule out ischaemic stroke. A detailed system-wise examination revealed mild right upper quadrant tenderness and hepatosplenomegaly on abdominal examination. Imaging revealed hepatosplenomegaly with gallbladder wall oedema and mesenteric lymphadenopathy. Blood culture was reviewed, revealing extensively drug-resistant (XDR) Salmonella Typhi. A diagnosis of XDR Salmonella bacteraemia leading to encephalopathy was made. The patient responded well to antibiotic therapy guided by the culture and sensitivity. Keywords: Salmonella, Complicated typhoid, XDR typhoid, Food hygiene, Speech disturbance, Ischaemic stroke.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis.

Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery. To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients. In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software. A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, P < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, P < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, P < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, P = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, P < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, P = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, P = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, P = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, P = 0.26] between the two groups. The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.

Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain: A Case Report from the Emergency Department

BackgroundRight upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. Case ReportThis case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. Why Should an Emergency Physician Be Aware of This?Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously.

T2-weighted imaging and dynamic contrast‑enhanced imaging in predicting the prognosis in patients with acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) is a syndrome with high 28- and 90-day mortality rates. Magnetic resonance imaging (MRI) has been widely used to diagnose and evaluate liver disease. Our purpose is to determine the value of the imaging features derived from Gd-DTPA-enhanced MRI for predicting the poor outcome of patients with ACLF and develop a clinically practical radiological score. This retrospective study comprised 175 ACLF patients who underwent Gd-DTPA-enhanced abdominal MRI from January 2017 to December 2021. The primary end-point was 90-day mortality. Imaging parameters, such as diffuse hyperintense of the liver on T2WI, patchy enhancement of the liver at the arterial phase, uneven enhancement of the liver at the portal vein phase, gallbladder wall edema, periportal edema, ascites, esophageal and gastric varix, umbilical vein patefac, portal vein thrombosis, and splenomegaly were screened. Cox proportional hazard regression models were used to evaluate prognostic factors and develop a prediction model. The accuracy of the model was evaluated by receiver operating characteristic (ROC) curves. During the follow-up period, 31 of the 175 ACLF patients died within 90 days. In the multivariate analysis, three imaging parameters were independently associated with survival: diffuse hyperintense on T2WI (p = 0.007; HR = 3.53 [1.40-8.89]), patchy enhancement at the arterial phase (p = 0.037; HR = 2.45 [1.06-5.69]), moderate ascites (vs. mild) (p = 0.006; HR = 4.12 [1.49-11.36]), and severe ascites (vs. mild) (p = 0.005; HR = 4.29 [1.57-11.71]). A practical radiological score was proposed, based on the presence of diffuse hyperintense (7 points), patchy enhancement (5 points), and ascites (6, 8, and 8 points for mild, moderate, and severe, respectively). Further analysis showed that a cut-off at 14 points was optimum to distinguish high-risk (score > 14) from the low-risk group (score ≤ 14) for 90-day survival and demonstrated a mean area under the ROC curve of 0.774 in ACLF patients. Gd-DTPA-enhanced MR imaging features can predict poor outcomes in patients with ACLF, based on which we proposed a clinically practical radiological score allowing stratification of the 90-day survival.

Ultrasonographic features of gallbladder wall thickening in dogs with hypoalbuminemia

Hypoalbuminemia has been considered as a cause of gallbladder wall thickening in humans and dogs. Recent study revealed that gallbladder wall thickening in dogs with hypoalbuminemia may not be associated with serum albumin/plasma levels within 48 h of ultrasound study. However, gallbladder wall edema may change within 48 h, and the ultrasonographic features of gallbladder wall thickening in dogs with hypoalbuminemia have not been reported. The purpose of this study is to describe the relationship between serum albumin levels within 24 h of ultrasound and gallbladder wall thickening, and to describe the ultrasonographic features of thickened gallbladder walls in dogs with hypoalbuminemia. 37 hypoalbuminemic dogs with gallbladder ultrasound images were retrospectively included. Ultrasound studies were reviewed, and gallbladder wall thickness, layering appearance, echogenicity, echotexture, distribution, evidence of gallbladder mucocele, and presence of peritoneal effusion were recorded. Additionally, serum albumin levels within 24 h of ultrasound study and the administerd sedation were recorded. The prevalence of gallbladder wall thickening in dogs with hypoalbuminemia was 13.5%. The 3-layer appearance of the gallbladder wall was observed in 4 dogs, and a single-layer gallbladder wall thickening in one dog. Diffuse thickening was observed in all 5 dogs. The serum albumin level of dogs with gallbladder wall thickening was not different (p = 0.14) from dogs without thickening. Gallbladder wall thickening was not common, occurring only with mild hypoalbuminemia, and was commonly associated with a 3-layer appearance and considered as gallbladder wall subserosal edema. Causes other than hypoalbuminemia may be responsible for thickening of the gallbladder wall in dogs with hypoalbuminemia.

Computed tomography findings of hepatobiliary systems in patients with immune checkpoint inhibitor-induced liver injury.

The incidence of immune checkpoint inhibitor (ICI)-induced liver injury has increased recently; however, its imaging characteristics remain unclear. This study aimed to characterize the computed tomography (CT) findings of ICI-induced liver injury. This was a single-center retrospective study of patients with ICI-induced liver injury who underwent CT between January 2020 and December 2021. Two board-certified radiologists independently evaluated the CT findings of the patients before the start of ICI therapy (pre-CT)and at the onset of ICI-induced liver injury (post-CT) to determine the presence or absence of imaging findings suggestive of hepatitis and cholangitis. ICI-induced liver injury was classified into three categories based on the CT findings: hepatitis alone, cholangitis alone, and overlapped (cholangitis plus hepatitis). A total of 19 patients were included in this study. Bile duct dilatation, bile duct wall thickening, non-edematous gallbladder wall thickening, hepatomegaly, periportal edema, and gallbladder wall edema were observed in the post-CT images of 12 (63.2%), 9 (60%), 11 (57.9%), 8 (42.1%), 6 (31.6%), and 2 (10.5%) patients, respectively. Wall thickening in the perihilar, distal, intrapancreatic bile duct and the cystic duct were observed in 53.3%, 60%, 46.7%, and 26.7% of the study population, respectively. Regarding the classification of ICI-induced liver injury, cholangitis alone was most common (36.8%), followed by overlapped (26.3%) and hepatitis alone (26.3%). Patients with ICI-induced liver injury demonstrated a higher incidence of biliary abnormalities than hepatic abnormalities on CT images; nonetheless, future studies with larger sample sizes are needed to validate these findings.

N‐terminal brain natriuretic peptide, cardiactroponin‐I, and point‐of‐care ultrasound in dogs with cardiac and noncardiac causes of nonhemorrhagic ascites

Nonhemorrhagic ascites (NHA) can be caused by cardiac diseases (cNHA) and noncardiac diseases (ncNHA). N-terminal brain natriuretic peptide (NT-proBNP), cardiac troponin-I (cTnI), and point-of-care ultrasound (POCUS) may differentiate between cNHA and ncNHA. We compared NT-proBNP and cTnI concentrations as well as POCUS findings in dogs presented with cNHA and ncNHA. Dogs (n = 60) were enrolled based on identification of NHA with an effusion packed cell volume < 10%. Blood samples were collected and POCUS was performed on all dogs. Dogs were diagnosed with cNHA (n = 28) or ncNHA (n = 32) based on echocardiography. The cNHA group was subdivided into cardiac non-pericardial disease (n = 17) and pericardial disease (n = 11). The NT-proBNP concentration (median; range pmol/L) was significantly higher in the cNHA group (4510; 250-10 000) compared to the ncNHA group (739.5; 250-10 000; P = .01), with a sensitivity of 53.8% and specificity of 85.7% using a cut-off of 4092 pmol/L. The NT-proBNP concentrations were significantly higher in the cardiac non-pericardial disease group (8339; 282-10 000) compared with the pericardial disease group (692.5; 250-4928; P = .002). A significant difference in cTnI concentration (median; range ng/L) between the cNHA group (300; 23-112 612) and ncNHA group (181; 17-37 549) was not detected (P = .41). A significantly higher number of dogs had hepatic venous and caudal vena cava distension in the cNHA group compared to the ncNHA group, respectively (18/28 vs 3/29, P < .0001 and 13/27 vs 2/29, P < .001). Gall bladder wall edema was not significantly different between groups (4/28 vs 3/29, P = .74). NT-proBNP concentration and POCUS help distinguish between cNHA and ncNHA.

Early diagnostic markers in predicting the severity of dengue disease

The aim of the present study was to determine whether the serum ferritin, the biomarker of an acute phase reactant and the gall bladder wall edema, an early indicator of capillary leakage can predict the severity of dengue fever. This study included 131 patients, who were between the age group of 18–80 years. The patients presented to our department with an acute illness, within the first four days of high temperature. The statistical analysis of this study was performed by using the Chi-square and independent Student’s t tests. The diagnostic markers are considered statistically significant, if the serum ferritin level is higher than 500 ng/ml and the gall bladder wall thickness is more than 3 mm. The present study observed that, 39 patients (89%) who had severe dengue (n = 44) revealed a significant gall bladder wall thickening, and this correlation was significant statistically (p < 0.000). It was also observed that, the ferritin levels have a highly significant positive correlation with the severity of dengue. The severe dengue patients had a mean ferritin level of 9125.34 μg/l, whereas the non-severe group had 4271 μg/l. This comparison was also statistically significant, as the p value was 0.003. We report that the serum ferritin levels have a highly significant positive correlation with the severity of dengue. The gall bladder wall edema during the third and fourth day of the illness was also associated with severe dengue. However, diffuse gall bladder wall thickening and high serum ferritin levels are also reported in various other conditions and their exact cause have to be determined by the correlation of associated clinical findings and imaging features.

Look Out for Fever: Clinical Profile of Dengue in Young Adults in a Tertiary Care Center in North India.

Background Dengue fever (DF) is a common viral disease, clinical manifestations of which vary from influenza-like illness (DF) to life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The aim of this article was to study the clinical profile of DF in young adults. Material and Methods This was an observational study conducted in the department of medicine over a period of 2 years (January 1, 2013-December 31, 2014). Patients aged between 18 and 30 years with serology proven (nonstructural protein 1 [NS1]/dengue immunoglobulin M [IgM]) DF were included in this study. The clinical and laboratory data was recorded and analyzed. Results Out of 418 cases, the incidence of DF, DHF, and DSS was 87.32, 7.66, and 5.02%, respectively. The most common presentations were fever (99.76%) followed by vomiting (29.43%), pain abdomen (17.94%), myalgias (13.16%), petechial rash (12.92%), and bleeding (10.29%). Dengue NS1 and IgM antibodies were positive in 87.3% and 88.12% of the patients, respectively. Ascites, splenomegaly, hepatomegaly, pleural effusion, gall bladder wall edema, and pericardial effusion were present in 8.13, 6.94, 6.70, 5.98, 2.63, and 0.72% of the patients, respectively. Complications included bleeding (10.29%), acute respiratory distress syndrome (1.67%), myocarditis (1.44%), seizures (1.44%), hemarthrosis (0.24%), and encephalopathy (0.24%). The mortality rate was 3.35% with death of 14 patients. Shock, bleeding, and elevated serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase levels predicted adverse outcome. Conclusion DF can present with a plethora of clinical manifestations in endemic areas. Adverse outcome is more likely if patients have elevated SGOT levels, shock, and bleeding. Continuous seroepidemiological surveillance is essential to control outbreak and minimize morbidity and mortality.

Ultrasonographic assessment of dengue fever and its correlation with platelet count

&lt;p&gt;&lt;em&gt;Background:&lt;/em&gt; Dengue virus infections are a significant threat to human populations particularly in the tropical and subtropical regions. This is mainly transmitted by Aedes aegypti mosquito from humans to humans. The main pathological mechanisms associated include thrombocytopenia, haemorrhagic diathesis with haemoconcentration. Ultrasonography is used because of its ability to detect plasma leakage signs and prediction of disease severity.&lt;/p&gt; &lt;p&gt;&lt;em&gt;Objective:&lt;/em&gt; To evaluate the usefulness of ultrasonographic findings of dengue fever and its correlation with platelet count.&lt;/p&gt; &lt;p&gt;&lt;em&gt;Methods:&lt;/em&gt; It was a prospective observational study, carried out in Bangladesh Medical College Hospital, Dhaka from May 2019 to August 2019. A total of 213 patients of suspected dengue fever during the epidemic were included in this study. All the cases were serologically diagnosed and evaluated with ultrasonographic findings. Platelet counts were estimated in all the cases and compared with findings recorded on ultrasonographic findings.&lt;/p&gt; &lt;p&gt;&lt;em&gt;Results:&lt;/em&gt; The mean age of the study population was 28.7 years. The male female ratio was 1.7:1. The common features on ultrasonography were thickened and oedematous gall bladder wall, mild to moderate ascites, pleural effusion (unilateral and bilateral), and hepatosplenomegaly. Thickened and oedematous gall bladder wall were observed in 68.8%, mild to moderate ascites 65.3%, bilateral pleural effusion 58.2 %, unilateral pleural effusion 40.4%, hepatomegaly 34.3 % and splenomegaly 13.6 % Platelet counts were significantly lower in abnormal ultrasonographic findings (&lt;em&gt;p&lt;/em&gt;=0.001).&lt;/p&gt; &lt;p&gt;&lt;em&gt;Conclusion:&lt;/em&gt; In a febrile patient with thrombocytopenia and positive dengue serology, ultrasonography of the abdomen is a useful tool to evaluate the severity of illness. Ultrasound findings of gall bladder wall oedema, ascites, and pleural effusion were correlated with the severity of thrombocytopenia. In epidemic scenarios, Ultrasonographic features may help in roughly estimating the platelet count even before serology and platelet results are available. Thus, it helps in treatment planning without waiting for the laboratory results.&lt;/p&gt; Bangladesh Med Res Counc Bull 2021; 47(1): 23-28

First report of a gallbladder hemangioma coexisting with gallstones: a case report and literature review of a rare finding

BackgroundGallbladder hemangioma is an exceptionally rare entity, with only ten cases reported in literature hitherto. The here described case is the first report of a gallbladder hemangioma coexisting with gallstones.Case presentationA 76-year-old male was hospitalized following repeated episodes of epigastric pain. Patient’s medical history included primary hypertension, type 2 diabetes mellitus, dyslipidemia, obesity and hyperuricemia. Physical examination revealed marked pain in the right hypochondriac region, and laboratory workup was notable for mildly elevated glycemia (125 mg/dL) and pancreatic amylase (60 IU/L). Abdominal ultrasound showed multiple gallstones, a thickened gallbladder wall and mild edema of the perivisceral adipose tissue as well as a hepatic angioma. During surgery, an incidental subserosal nodule of about 1 cm was detected within the gallbladder fundus. After surgery, the clinical course was uneventful and the patient was discharged. Histopathological examination of the subserosal nodule showed multiple dilated vascular channels within a sclerosing matrix, a finding consistent with a cavernous hemangioma. Diffuse chronic cholecystitis was also present.ConclusionsGallbladder hemangiomas represent a rare, likely underdiagnosed condition which can be undetected during the preoperative workup.

Complications of Dengue Infection in Admitted Patients at Rehman Medical Institute: A Retrospective Study

Dengue infection is an arthropod-borne Flavivirus infection that spread through female mosquitoes (Genus Aedes). Dengue infection is a major health challenge in the tropical and subtropical parts of the world. Methods: This is a retrospective study conducted at Rehman Medical Institute (RMI). Data were retrieved from the Clinical test reports of confirmed dengue infection during the timeline; June to October (monsoon season) of the year 2021. Clinical as well as biochemical parameters were considered during the data assembling and assessment process. Results: Out of 156 suspected cases of dengue infection, 94 were confirmed through laboratory testing. 83 patients tested positive with Dengue NS1 antigen while after re-screening 94 cases (54 male patients and 40 female patients) were confirmed by Dengue serology (IgM antibodies) test. According to our study results, among a set of varied symptoms, malaise (99%) was the most common clinical presentation, along with 94% fever. Some patients with severe dengue infection developed serious illnesses including encephalopathy (8.5%), hypokalemic paralysis (6.3%). Moreover, 8.5% of patients were presented with Cholecystitis seen as Edematous Gallbladder wall on ultrasound scans, and 1% of the patient developed acute Pancreatitis. Fortunately, no casualty was reported due to dengue at RMI-General hospital. Conclusion: In our setup, Fortunately, no death was reported but a substantial number of patients suffered from serious complications such as neurological and hemorrhagic conditions along with communal clinical manifestations. Despite much reported data still, further investigation and monitoring are needed to comprehend the contemporary condition of the prevalence of dengue infection in Khyber Pakhtunkhwa, Pakistan.

Clinical Features and CT Imaging Analysis of Hepatic Sinuscase-Syndrome and Budd-Chiari Syndrome.

ObjectiveThis study aimed to analyze the clinical features and computed tomography (CT) manifestations of hepatic sinusoidal obstruction syndrome (HSOS) induced by Gynura segetum, a Chinese herbal medicine, so as to improve the clinical understanding and diagnosis of the disease.MethodsRelevant clinical and laboratory parameters and CT imaging data of 20 patients with HSOS confirmed by liver biopsy were retrospectively analyzed and compared with 16 patients with Budd-Chiari syndrome (BCS).ResultsLevels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and glutamyl transpeptidase increased significantly (p < 0.05) in HSOS patients compared to the BCS patients, while the albumin level and prothrombin time, which are indicators of liver synthesis function, decreased and prolonged significantly, respectively. All 20 patients with HSOS had manifestations of ascites and heterogeneous hypoattenuation on CT, including 18 cases (90%) with heterogeneous enhancement (characteristic map-like enhancement), 17 (85%) with hepatomegaly, 18 (90%) with gallbladder wall oedema, and 16 (80%) with stenosis of main hepatic veins and characteristic “clover-like” enhancement at the second porta hepatis.ConclusionBoth HSOS and BCS are post-sinusoidal portal hypertension, but have different etiologies and durations. Although they both cause liver congestion, the clinical manifestation of HSOS is acute liver injury. The CT manifestations are characterized by ascites, map-like enhancement and heterogeneous hypoattenuation of the liver parenchyma, and stenosis of the main hepatic veins. BCS is often found in the stage of decompensated liver cirrhosis, resulting in liver shrinkage, splenomegaly, and ascites.

An Observational Study Of Dengue Induced Hepatic Dysfunction Ina Tertiary Care Hospital Of Gkgh Bhuj

INTRODUCTION: Dengue infection is a major health problem worldwide including our country. Globally the incidence of Dengue has grown dramatically in the recent years. Every year during the monsoon months and later, many parts of the country witness outbreak of dengue infection. 2020 was no exception and we experienced an outbreak of this vector borne disease in Bhuj. An analysis of these patients revealed that in addition to the classical features of fever, body ache, rash and thrombocytopenia and bleeding tendency, there were other features such as liver dysfunction including a preferential rise of SGOT, hepatomegaly, splenomegaly, ascites, gallbladder wall edema and pericholecystic fluid collection.OBJECTIVE: To study clinical, biochemical and radiological changes in the liver of patients with Dengue fever.METHOD: observational and cross-sectional study was conducted on a 50 suspected cases of Dengue fever admitted and diagnosed at GKGH hospital Bhuj in October 2020. Detailed history, clinical examination, biochemical parameters, radiological investigation for liver function was done in all patients. All patients were treated as per NVBDCP guidelines. RESULTS: all patients in our study had hepatic dysfunction in the form of elevated SGOT above normal limits. CONCLUSIONS: Our study shows that there are certain features of Dengue that are not known to be usually associated with it. The presence of raised liver enzymes in all patients (SGOT &gt; SGPT), ascites, hepatomegaly, splenomegaly, and gallbladder edema and pericholecystic fluid collection.

Pulmonary arterial thromboses and gall bladder wall oedema in a cat with bronchioloalveolar carcinoma

AbstractAn 11‐year‐old male neutered British Shorthair cat presented with acute collapse, dyspnoea and paraparesis. Left atrial enlargement and left‐sided congestive heart failure were excluded by point‐of‐care ultrasonography, and gall bladder wall oedema was detected. Comparative venous blood gas analyses confirmed ischaemia of the hindlimbs, and echocardiography was consistent with pulmonary hypertension. The patient was euthanased and a postmortem examination revealed pulmonary artery thromboses associated with bronchioloalveolar carcinoma.

Occurrence and clinical significance of abnormal liver findings by ultrasound in captive owl monkeys.

Imaging diagnostic methods are essential for a complete understanding of the liver function and may aid in early detection of hepatic disorders. Sixty-nine owl monkeys were grouped in three age groups (AG): AG1 (<2years old, n=14), 2 (2-6years old, n=21), and 3 (>7years old, n=34). The animals were evaluated by ultrasound, liver function tests, and hemogram. The ultrasound revealed abnormal findings in the parenchyma ("starry sky" and steatosis) and/or in the gallbladder (cholelithiasis, septum, and wall edema) in 17 individuals, with higher incidence in AG3 individuals. Seven hepatic individuals showed alterations in the blood tests. Our study reported the occurrence of abnormal liver findings by ultrasound in owl monkeys and their associated clinical analyses. We recommend the regular use of ultrasound to evaluate liver condition in owl monkeys, particularly in old individuals.

Clinical profile and outcomes of dengue fever during monsoon season at a tertiary care hospital in South India

Background: Dengue is a mosquito-borne infectious disease of the tropical and subtropical countries which is rapidly becoming a global burden. It is caused by any of the four serotypes of dengue virus. Dengue disease presentation varies from mild fever with myalgia and fatigability to severe conditions of dengue haemorrhagic fever and shock syndrome. This study describes the clinical features, laboratory parameters and outcomes of the dengue fever patients during the monsoon season in a tertiary care hospital.Methods: This is retrospective, single centre study carried out at Yenepoya medical college and hospital (YMCH), Mangalore a coastal town in southern India. All patients who were adults (aged&gt;16 years), positive for rapid (NS1 antigen) test or dengue IgM Elisa and admitted from 1-5-2019 to 31-9-2019 (monsoon season) were included in this study. Data was collected from the medical records of YMCH.Results: The male to female ratio of patients in this study was about 4:1. About 70.1% belonged to the age group between 16-35 years. The predominant symptoms on admission were fever, headache, myalgia, nausea and vomiting, abdominal pain, loose stools, bleeding manifestations and skin rashes. Average days of hospitalization are 5.88 days (SD 2.94). Thrombocytopenia leukopenia raised hematocrit and transaminases are the commonly observed laboratory findings. Ascites, pleural effusion, gall bladder wall edema, sepsis, bradycardia, hypotension, ARDS, and acute kidney injury are the complications observed during the illness. Mortality rate in this study is 1.9%.Conclusions: As seen in this study dengue fever is predominantly affecting the younger age group. The early confirmation of diagnosis, identifying the warning signs and prompt supportive management will help in preventing the further complications and in reducing the mortality. Increased public awareness and vector control measures are important factors to be taken into consideration in the prevention of dengue.

Grayscale and Spectral Doppler Ultrasound in the Diagnosis of Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome After Hematopoietic Stem Cell Transplantation in Children

The aim of this study is to determine the ultrasound criteria in the diagnosis of hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) after hematopoietic stem cell transplantation (HSCT) in children. A total of 158 pediatric patients underwent HSCT between January 2016 and January 2018. In all, 71 patients with clinically suspicious hepatic VOD/SOS have been followed with serial ultrasound examinations. Hepatomegaly, gallbladder wall thickening, ascites, pleural effusion, reverse flow in the portal vein, and diameter and peak systolic velocity of the hepatic artery were evaluated. Patients were divided into 2 groups retrospectively: VOD/SOS and non-VOD/SOS. The predictive value of all findings was determined, respectively. Gallbladder wall thickening, increase of diameter and peak systolic velocity of the hepatic artery, and the presence of ascites are highly predictive for VOD/SOS (P=0.001 and < 0.05). The reversed portal venous flow was developed in 3 patients in the VOD/SOS group, no significant difference was found between the 2 groups (P>0.05). Hepatomegaly was recorded in 29 (70.7%) patients in the VOD/SOS group, 13 of them was presented related to a primary disease. Pleural effusion is not associated with the diagnosis of VOD/SOS (P>0.05). Gallbladder wall edema, an increase of peak systolic velocity of the hepatic artery, and the presence of ascites are highly related to the diagnosis of VOD/SOS in children after HSCT. Ultrasound findings must be correlated with clinical criteria.

Clinical characteristics of two-hundred thirty-two dogs (2006-2018) treated for suspected anaphylaxis in Perth, Western Australia.

To describe the clinical features of dogs treated for suspected anaphylaxis in Perth, Western Australia. Single-centre observational case series with retrospective and prospective phases. This was a two-phase study of dogs with clinical suspicion of anaphylaxis presenting to the emergency service of a university teaching hospital. Dogs required evidence of, and appropriate treatment of, a type 1 hypersensitivity reaction as well as two or more organs affected (or cardiovascular signs alone) to be included. Phase 1 includes retrospective case series of 186 dogs (March 2006-December 2018). Phase 2 includes prospective descriptive case series of 46 dogs (October 2017-July 2018) focused on clinical signs. In phase 1, 88 (47%) dogs had evidence of insect exposure prior to the acute event. One hundred forty (75%) dogs had dermatological signs, 141 (76%) had gastrointestinal signs and 129 (69%) had cardiovascular signs. Ninety-two (49%) dogs had vasoconstrictive shock (5 with bradycardia), 24 (13%) had vasodilatory shock, 8 (4%) had mixed vasodilatory and vasoconstrictive shock and 5 (3%) had unclassifiable shock. On focused abdominal ultrasound, 42 of 71 (59%) dogs had gallbladder wall oedema and 3 of 71 (4%) dogs had peritoneal free fluid. In phase 2, the distributions of insect exposure, organ dysfunction and sonographic abnormalities were similar to phase 1. Dogs presenting with suspected anaphylaxis showed a broad range of presentations. Dermatological signs were absent in a proportion of dogs, vasoconstrictive shock was more frequent than vasodilatory and unique features of shock were identified. This study highlights the challenges of diagnosis based on presenting features alone.