Tourniquet Test Research Articles

Pathogenesis, Symptoms and Diagnosis, and Prevention of Dengue Hemorrhagic Fever in Adults

Dengue Hemorrhagic Fever (DHF) is an infectious disease caused by the dengue virus, characterized by symptoms such as fever, muscle or joint pain, leukopenia, rash, lymphadenopathy, thrombocytopenia, and hemorrhagic tendencies. In DHF, there is plasma leakage leading to fluid accumulation in body cavities, and in severe cases, it can progress to Dengue Shock Syndrome, characterized by shock. The illness is mainly spread by Aedes aegypti and Aedes albopictus mosquitoes, presenting a substantial worldwide health issue. The diagnosis of DHF requires the presence of several criteria: fever or recent history of acute fever lasting 2-7 days, often biphasic; at least one hemorrhagic manifestation such as positive tourniquet test, ecchymosis, mucosal bleeding, hematemesis, or thrombocytopenia; and evidence of plasma leakage. Young adults are particularly susceptible to dengue fever due to their frequent outdoor activities. In Padang City, West Sumatra Province, in 2020, the age group most affected by the disease was adults aged 15 to 44 years.

Photoacoustic/ultrasound dual-modal imaging of human nails: A pilot study

Traditional diagnostic techniques including visual examination, ultrasound (US), and magnetic resonance imaging (MRI) have limitations of in-depth information for the detection of nail disorders, resolution, and practicality. This pilot study, for the first time, evaluates a dual-modality imaging system that combines photoacoustic tomography (PAT) with the US for the multiparametric quantitative assessment of human nail. The study involved a small cohort of five healthy volunteers who underwent PAT/US imaging for acquiring the nail unit data. The PAT/US dual-modality imaging successfully revealed the fine anatomical structures and microvascular distribution within the nail and nail bed. Moreover, this system utilized multispectral PAT to analyze functional tissue parameters, including oxygenated hemoglobin, deoxyhemoglobin, oxygen saturation, and collagen under tourniquet and cold stimulus tests to evaluate changes in the microcirculation of the nail bed. The quantitative analysis of multispectral PAT reconstructed images demonstrated heightened sensitivity in detecting alterations in blood oxygenation levels and collagen content within the nail bed, under simulated different physiological conditions. This pilot study highlights the potential of PAT/US dual-modality imaging as a real-time, noninvasive diagnostic modality for evaluating human nail health and for early detection of nail bed pathologies.

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.

Rash and Fever in a Returned Traveler.

A 21-year-old, otherwise healthy female presented to the emergency department with fever among other nonspecific symptoms after recently returning from Ghana. On physical exam, she had a characteristic upper extremity rash, and a tourniquet test revealed numerous petechiae. The diagnosis of dengue was suspected and subsequently confirmed. Dengue is one of many viral illnesses that should be considered in returning travelers presenting with fever and other nonspecific symptoms. Emergency physicians must keep a broad differential when evaluating fever in returned travelers and prioritize history and physical exam findings to help narrow the diagnosis and provide appropriate management and supportive care while awaiting further confirmatory testing.

Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis.

Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis. PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05. Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases. These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.

Dengue and Malaria Co-infection in a Young Adult with Atypical Feature

As an endemic zone, malaria and dengue coinfection can be expected in Bangladesh, although there have not been enough case reports of such coinfection. We describe a previously healthy 22-year-old male from Dhaka, with a history of travelling to Coxs-Bazar 3 weeks ago, presented with fever with chills and rigors, generalized weakness and cough for 2 weeks. Clinical examination showed tachycardia, hypotension, subconjunctival haemorrhage and positive tourniquet test. Lab reports showed NS1-Ag positive, thrombocytopenia, progressive anaemia, mild hyperbilirubinemia. He was treated initially for dengue haemorrhagic fever. His laboratory parameters started improving; however, he had persistent fever with chills and rigors daily and persistent coughing. Peripheral smear for Malaria showed schizonts and trophozoites of Plasmodium falciparum and ICT for malaria was positive. He recovered following treatment with IV fluids and oral artesunate. The presence of fever even in a critical phase of dengue, the typical rise of temperature daily, progressive anaemia, mild jaundice and specific travelling history gave a clue of coinfection with Malaria. On follow-up, after 2 weeks, he had no symptoms, and all the laboratory parameters were normal. challenge was the atypical features like dry cough and exertional dyspnoea. The timely diagnosis and appropriate treatment were crucial for prognosis of this patient. Bangladesh J Medicine 2024; 35(1): 38-41

Reduced Vitamin C Levels in Patients with Bleeding of Unknown Cause and Generalized Joint Hypermobility

Introduction Vitamin C is essential for the synthesis of collagen. Ehler-Danlos syndrome (EDS) is a group of collagen disorders associated with generalized joint hypermobility (HM), bleeding and bruising. The genetic cause of the HM EDS subtype (hEDS) is unknown. Referral to haematology clinics may result in the diagnosis: bleeding of unknown cause (BUC), where no specific haemostatic treatment is available. However, it is a clinical experience, published in many textbooks, that bleeding, and bruising associated with EDS improve by oral intake of vitamin C. No previous studies examined vitamin C levels in patients with BUC. The aim of the study is to investigate the association of vitamin C levels with HM and vascular fragility in patients with BUC. Methods Patients with bleeding tendency are referred to our Haemophilia Center. Following ISTH-BAT score, normal coagulation test (INR, APTT, fibrinogen, F8, F9, F11, F13, VWFAg, VWFRist) and inconclusive results of flow cytometry analysis of platelet function, patients are diagnosed with BUC. Patients with a high ISTH-BAT score &amp;gt; 10 were included in this study. We performed clinical examinations by a tourniquet test for capillary fragility and a Beighton score for generalized HM. A skin extensibility test was performed by pulling on the skin off the forearm and the lateral side of the throat until resistance was met. The test was considered positive (abnormal) if the skin extended more than 2 cm in both sites when pulled. Germline DNA was analyzed by whole genome sequencing (WGS) analysis and an in silico panel of 170 genes associated with bleeding and generalized HM was examined. Additionally, homozygous polymorphism in vitamin C genes ( GULOP, SLC23A1, SLC23A2, SVCT1, HP, GST and SOD2) known to cause reduced vitamin C levels, were assessed Vitamin C analysis: The participants received oral and written guidelines regarding intake of vitamin C in relation to the blood sample. The guidelines included no vitamin C supplements for 3 days before the blood sampling and no intake of vitamin C rich food on the day of the appointment. Plasma samples were immediately acidified by addition of 10% meta-phosphoric acid to ensure the stability of ascorbic acid, and subsequently analyzed by high-performance liquid chromatography. Severe vitamin C deficiency was defined as &amp;lt;11µM, deficiency as &amp;lt; 23 µM, suboptimal status as 23-49 µM and adequate status as &amp;gt;49 µM. Results Sixty probands and 20 healthy age- and gender-matched controls (HC) were included. Most patients were women (56/60, 93%), median age 48 (range 21- 75) and median BAT score 13 (range 10-21). By WGS a 67-year woman with Beighton score 7 was diagnosed with Noonan syndrome due to a pathogenic variant in PTPN11 (c.922A&amp;gt;G). Also, a 62-year woman without HM was diagnosed with mild FV deficiency due to a heterozygous variant in F5 (c.449A&amp;gt;G). No other causal variants were identified. In a patient with a homozygous variant in SLC23A1, vitamin C level was suboptimal 42µM.Suboptimal vitamin C levels were found in 19/60 patients and 2/20 HC. One patient was severely vitamin C deficient (7µM). Vitamin C levels were significantly lower in patients compared to HC (median 56 µM vs 76 µM; p = 0.012). Beighton score was positive in 29/60 patients and 1/20 HC (p&amp;lt;0.001). In 18/60 patients versus 0/20 HC the skin extensibility test was abnormal (p = 0.01). In 12/29 patients with a positive Beighton score the test for skin extensibility was also positive indicating a diagnosis of hEDS. Tourniquet test was positive (&amp;gt; 10 petechiae) in 18/60 patients and 4/20 HC (p&amp;gt;0.5). Patients with positive Beighton scores had significantly higher BAT scores than patients without HM (P= 0.014). No significant associations were found between vitamin C levels, a positive Beighton score, a positive Tourniquet test or a high BAT score respectively. Conclusions We found that a high proportion of patients with BUC have generalized HM, abnormal skin extensibility and positive tourniquet test. Indeed, patients with HM had increased ISTH-BAT scores compared to patients with negative Beighton scores. Our data support that hEDS may be an underlying cause of BUC. Further studies are needed to determine the genetic background of hEDS. Levels of vitamin C were reduced in patients with BUC compared to age and sex matched control. Our results could pave the way for a randomized study of vitamin C supplements versus placebo for bleeding and bruising in patients with generalized HM and BUC.

Acute Effect of KinesioTaping on Technical Skills of Wheelchair Basketball Players

The purpose of this research kinesiology taping (KT) is to increase the blood and lymph circulation under the skin and provide the athlete with a comfortable movement capacity. For this purpose, we aim to examine the effect of KT on the shoulder and supraspinatus muscles of wheelchair basketball players on the technical skills of athletes. Ten male wheelchair basketball players between the ages of 20 and 40 participated in the study. In the study, kinesiology tape was applied to the shoulder and supraspinatus muscle regions of the athletes. To evaluate the effect of KT regional shooting (2p), tourniquet, slalom, and sprint tests were applied before and after taping. SPSS 25 statistical program was used for the analysis of the data. The significance value for the analysis was accepted as 0.05. According to the research findings, it was determined that KT was effective in the 2nd, 3rd, and 4th regions in shooting from 5 regions, and KT was also effective in 20m sprint, right tourniquet throw, and slalom skills with and without the ball (p&amp;lt;0.05). We can say that KT affects shots made from positions that see the basket from the opposite and diagonal, increasing the dribbling skill and sprint performance. During the competition, it is recommended that the athletes do it on the shoulder and supraspinatus muscle areas.

Predictive Diagnostic Value of the Tourniquet Test for the Diagnosis of Dengue Infection in Pediatric Age Group Children

Predictive Diagnostic Value of the Tourniquet Test for the Diagnosis of Dengue Infection in Pediatric Age Group Children

Clinical spectrum of dengue fever in patients admitted to a tertiary care hospital in Bangladesh

Background: Dengue fever is a viral infection transmitted by mosquitoes and is a significant public health problem in many tropical and subtropical countries, including Bangladesh. The clinical spectrum of dengue fever can vary widely, ranging from asymptomatic infection to severe and potentially life-threatening illness. In this study, we aimed to describe the clinical spectrum of dengue fever in patients admitted to a tertiary care hospital in Bangladesh. The aim of the study was to observe the clinical spectrum of dengue fever patients. Methods: This prospective observational study was conducted at the department of medicine, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. The study duration was 7 months, from June 2022 to December 2022. During this period, a total of 65 cases of dengue fever cases admitted to the hospital for treatment were included in the study, who had a hospital stay of at least 3 days. Results: The mean age of the participants was 30.78 years, and the male: female ratio was 1:1.95. 86.15% of the participants had no comorbidities, while diabetes and hypertension were observed in 6.15% of patients each. Patients' mean temperature had been high at the first check-up and dropped slowly to normal levels throughout the following check-ups, but the mean platelet count had significantly dropped from the first check-up throughout the following check-ups, improving only at the 6th check-up. ≤20,000 platelet count was observed in 6.15% at the first check-up, 9.23% at the 2nd check-up, 15.38% at the 3rd, 5.41% at the 4th, 15% at the 5th, and 0% at the 6th check-up. The most common warning signs were a positive tourniquet test (21.54%), vomiting (16.92%), and abdominal pain (15.38%). Hospital stay duration was &lt;1 week for 95.38% of participants, and during discharge, only 3 patients had minor complications, with 3.08% mortality. Conclusions: The study observed a higher prevalence of dengue among younger age groups, and females had a higher prevalence in the study. The regular-interval check-ups revealed that dengue severity progressed slowly, and did not become worse immediately after the infection, rather continued to progress adversely slowly throughout the check-ups. Hospital stay was &lt;1 week for the majority of the participants, and minor mortality was observed in the study.

Seropositivity of dengue cases at a tertiary care centre in Chhindwara, Madhya Pradesh: A three year trend

BackgroundDuring the recent decades, dengue virus infection has been emerged as a major public health problem. Dengue is one of the important mosquito borne infections causing high mortality and morbidity of humans. Methods: This study was carried out from October 2018 to December 2020. A total of 354 serum samples of clinically suspected dengue patients were tested for immunoglobulin M (IgM) anti-dengue antibodies by dengue monoclonal antibody capture enzyme-linked immunosorbent assay (NIV DEN IgM Capture MAC ELISA). Seasonal variations, age and sex wise incidences were also determined. ResultsTotal of 354 serum samples were processed from October 2018 to December 2020. Each year males were mostly infected with Dengue 08, 10, and 03 in 2018, 2019, and 2020, respectively. Age group 11–20 was found to be mostly infected by Dengue in case of both male and female. The prevalence of Dengue in each year was from July to November might be due to the rainy season. Clinical characteristics of patients such as fever, headache, abdominal pain and nausea/vomiting, retro-orbital pain, epistaxis, petechiae, altered sensorium, positive tourniquet test were reported. ConclusionsContinuous dengue virus surveillance is required for monitoring of dengue virus so that early detection can be carried out. Effective vector control measures should be implemented for early detection of impending outbreak and to initiate timely control measures.

Triage of Pediatric Dengue Disease Cases at KBNIMS Kalaburagi Outpatient Clinic – A Retrospective Observation Study

Background and aim Dengue infection is a systemic and dynamic disease that is complex in its manifestations. However managing it is relatively straightforward inexpensive and effective in saving lives if appropriate and timely measures are taken. This study aimed to define case severity based on clinical features a simple tourniquet test that can be performed easily at the OPD level laboratory parameters USG findings and particularly the inferior vena cava IVC collapsibility index.Material and Methods A retrospective observational study involving 80 paediatric dengue patients presenting to OPD at Khaja Banda Nawaz Teaching and General Hospital Kalaburagi from Dec 2019 to July 2021 was conducted.Results Out of 80 patients 51 63 patients presented with features of dengue fever 25 31 patients presented with Dengue Haemorrhagic Fever DHF and 4 5 patients presented with Dengue Shock Syndrome DSS. Thirty six patients 71 with dengue fever were managed on an OPD basis and 15 29 were managed in OPD day-care. Twenty nine patients 36 showing features of DHF and DSS were hospitalised.Conclusion This study showed that a well-managed front-line response reduces hospital admissions and complications. Ultrasound examination helps identify the plasma leakage and inferior vena cava collapsibility facilitating fluid management.

Sosialisasi Pencegahan DBD (Demam Berdarah Dengue) pada Masyarakat Desa Sumuranja Pulo Ampel Serang

Dengue Hemorrhagic Fever (DHF) is a disease caused by Dengue virus infection transmitted through the bite of the Aedes aegypti mosquito which is characterized by sudden fever, headache, pain behind the eyeball, nausea and bleeding manifestations such as positive tourniquet (rumple lead) tests, red spots on the skin (petekie), nosebleeds, bleeding gums and so on. Implementation Of the method used in this activity is Socialization (Counseling) with lectures and questions and answers. Lectures were conducted to socialize information about epidemics, eradication and dengue management. The purpose of this activity is to provide public knowledge and understanding of the dengue epidemic in their environment and provide community knowledge and understanding of dengue fever management and eradication in the surrounding environment. The socialization of dengue disease prevention and eradication activities has been carried out well and the participants were very enthusiastic in participating in the activity. Most of the participants understood the material presented on how to prevent and eradicate dengue disease

Changes in severity of clinical pattern of dengue infection and its management: a cross-sectional study a tertiary care hospital

Background: Dengue fever is a debilitating viral disease, transmitted by mosquitoes, and causes sudden fever, and acute pain in the joints. Aedes Aegyptus mosquitos are responsible for dengue fever. More than 500,000 people are affected by dengue fever each year. In Bangladesh, over 15,000 cases of dengue are reported each year. It is high time to take some measures to control this viral disease. The aim of the study was to investigate the clinical manifestation of dengue fever in tertiary care hospitals.Methods: It is a prospective cross-sectional study that was carried out in the pediatric department of Dhaka medical college hospital (DMCH) over one year and was conducted with 106 patients.Results: The finding had females dominant over males. Minimum and maximum ages were 1 and 14 respectively. All patients (106, 100%) had fever. Around one-third of the patients (34,32%) had headaches. Patients had experienced rash and vomiting. The Tourniquet test came out positive for about one-fifth of the patients (21, 19.8%). About half of the study population (50, 47.2%) had dengue fever, around two-fifth of the patients (44, 41.5%) experienced dengue hemorrhagic fever (DHF) and only 12 patients (12, 11.3%) were diagnosed with dengue shock syndrome (DSS). The majority of the patients (102, 96.22%) were given isotonic fluid. Ns1 antigen for dengue 65 cases and IgM &amp; IgG for dengue 32 cases were positive.Conclusions: Dengue is a rapidly emerging pandemic disease in many parts of the world, especially in Bangladesh. There is no accurate treatment to treat dengue patients. However, more illness and death could be prevented if countries regularly monitor the circulation of viruses in the mosquitos and take control measures before there are consequential outbreaks.

Conditioned Pain Modulation Is Not Impaired in Individuals with Frozen Shoulder: A Case-Control Study.

Frozen shoulder (FS) is a poorly understood condition resulting in substantial shoulder pain and mobility deficits. The mechanisms behind FS are not yet fully understood, but, similar to other persistent pain states, central pain mechanisms may contribute to ongoing symptoms in this population. The objective of this research was to investigate conditioned pain modulation (CPM) in people with FS compared with pain-free individuals. A total of 64 individuals with FS and 64 healthy volunteers participated in this cross-sectional study. CPM was assessed by using the pressure pain threshold (PPT) and an occlusion cuff (tourniquet test) as the test and conditioning stimulus, respectively. The absolute and percentage of change in PPT (CPM effect) as well as pain profiles (pro-nociceptive vs. anti-nociceptive) of individuals with FS and healthy controls were calculated. No significant differences in the absolute change in the PPT or CPM effect were found in people with FS compared to pain-free controls. Moreover, no between-group differences in the percentage of subjects with pro-nociceptive and anti-nociceptive pain profiles were observed. These results suggest that endogenous pain inhibition is normally functioning in people with FS. Altered central pain-processing mechanisms may thus not be a characteristic of this population.

Діагностична та прогностична значущість судинної молекули міжклітинної адгезії-1 (sVCAM-1) у дітей із бронхіальною астмою

З метою вивчення рівня судинної молекули міжклітинної адгезії-1 (sVCAM-1) у дітей із бронхіальною астмою на різних етапах захворювання нами обстежено 69 дітей віком від 6 до 17 років, які страждають від персистуючої бронхіальної астми, в період загострення та ремісії та 15 практично здорових дітей групи контролю. Проводили манжетову пробу та визначали рівень S-нітрозотіолу в сироватці крові для оцінки функції ендотелію. Вивчали рівень sVCAM-1 у сироватці крові імуноферментним методом. Установлено наявність ендотеліальної дисфункції у всіх дітей, хворих на бронхіальну астму. Відмічено значне підвищення рівня sVCAM-1 у сироватці крові як у період загострення, так і в період ремісії захворювання, що свідчить про триваючий вплив на ендотелій та формування стійкого хронічного запалення.

Islands of White in a Sea of Red: A Cutaneous Manifestation of Dengue Fever in a Pregnant Woman

Dengue fever is a significant public health problem in Asia, resulting in serious morbidity and even mortality. It is mainly known for causing severe constitutional symptoms and bleeding, often resulting in haemorrhagic shock. Dengue fever may manifest cutaneously in several forms. These include petechial rash, maculopapular rash and what has been termed as islands of white in a sea of red. Most can be attributed to capillary fragility, which led to tests such as the tourniquet test. This case highlights the dengue fever cutaneous presentation of islands of white in a sea of red in a multigravida woman during her first trimester. Her husband and son who was infected at the same time did not develop similar skin condition but developed the more common maculopapular and petechial rashes. The pathophysiology of such lesions is not well understood, and its relation to pregnancy is not known. Blood investigations were typical of dengue fever. The outcome of the patient’s pregnancy was also normal. This case highlights the need for doctors to look out for such lesions in dengue patients.

Value of Modified Duran’s Test in Clinical Diagnosis of Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is a medical condition, the most common, most important, and best defined, and the most carefully studied of all nerve entrapment syndromes. Objective: Our study aims to evaluate clinical tests in the diagnosis of CTS with special reference to modified Duran’s test regarding specificity and sensitivity. Patients and Methods: A prospective study carried out on 300 hands in 240 patients with symptomatic CTS was taken, from August 2015 to February 2017, at Erbil Teaching hospital (Orthopedic department). History, clinical examination, and Electrophysiological by Electromyography and Nerve conduction study and 250 persons without symptoms on 300 hands were taken as a controlling group. We applied the five clinical provocative tests on each group, Phalen’s test, Tinal’s test, original Duran’s test, arm Tourniquet test, and Reversed Phalen’s test. In this research, we compared former tests by our test modification (Duran’s test), considering specificity, accuracy, and sensitivity. Results: Findings show that the modified Duran’s test was the most specific (94%), accurate (94%), and sensitive (94%) in comparison with the other provocative tests. The modified Duran test had the highest positivity rate, according to the cases in less than 1-month history of symptoms it reached: 81.8% which was higher than the result of the previous tests in comparison to the previous clinical tests. Its mean time was 11.5 s. Conclusions: Modified Duran’s test was simple, noninvasive, most sensitive, and most specific in comparison to other clinical tests. Furthermore, the reaction time of Modified Duran’s test was the shortest,

Recent Dengue Fever Outbreak in Pediatric Age Group

Objective: To evaluate Dengue fever outbreak in pediatric age group. Methods: This experimental study was conducted at tertiary medical college and hospital, Dhaka from January 2019 to December 2019, where a total of 100 children were selected consecutively based on clinical features mentioned in National Guidelines for Clinical Management of Dengue Syndrome, Bangladesh 2018. Result: During the study, where most of the patients belong to lower economic status, 60% patients had rash with itching on their body, 9% had low WBC count, 30% of patients had platelet count 51- 100*10^9/L and 24% with 21-50*10^9/L. Conclusion: From our result, we can conclude that, most of the children with dengue fever presented with high grade continued fever with vomiting and abdominal pain. More than half of the patients showed bleeding manifestation even with negative tourniquet test. Further study is needed for better outcome.

Clinical diversity and outcome of dengue fever outbreak-2019 described in a hospital of Dhaka

Objectives: This study aimed to discuss demographic profile, variation in clinical feature, laboratory analysis, clinical severity, and consequences of treatment in dengue fever. Materials and Methods: This was a prospective observational study. All patients included in the study were admitted with fever and diagnosed with dengue fever either by serological test or antigen test. Results: The majority (92.85%) of children came from urban areas. Male children were predominately (59.52%) affected. Common clinical features were fever (100%), vomiting (65.8%), abdominal pain (31.7%), rashes (41.6%), loose motion (34.1%), and bleeding manifestation (30.50%). Tourniquet test was positive in 34.12% of cases. Pleural effusion was present in 15.87% and ascites were present in 13.49% of cases. Peritonitis developed in 2.38% of patients. Approximately 7.93% of the patients had central nervous system involvement and 1.5% of cases came with active convulsion. Regarding investigations, leukopenia (42.85%), thrombocytopenia (69.84%), increased hematocrit (35.7%), and elevated serum glutamic-pyruvic transaminase (SGPT) (42.06%) were present. Approximately 43.65% of children came with dengue fever, 30.95% of children came with dengue hemorrhagic fever and 25.39% of children came with DSS. In DSS 100% of patients came with hypotension and tachycardia and 78.12% of patients came with compensated shock. Leukopenia (55.55%) and raised hematocrit (60%), elevated SGPT (45.28%), and decreased albumin level (60%) were prominent in DSS. There was no case fatality. Conclusion: Dengue fever’s severity and clinical variation increase day by day. As there is no vaccine against dengue in our country, we will try to improve our public awareness for prevention and continuous serological surveillance will be needed to achieve the goal.