Far beyond our typical dengue fever on three cases reported: weakness, visual loss and aphasia as initial clinical presentations?

e19527 Background: CML commonly presents with abdominal pain and swelling, and in up to about 50% of cases it is discovered incidentally due to abnormally elevated white blood cell (wbc) counts in circulation. Some present with bleeding tendency, others nusual presentations including hearing and visual loss whose pathogenesis is poorly understood also occur. Priapism presents rarely, attributed to hyperviscosity complicating wbc counts ≥ 250x109/litre. Nonspecific symptoms also present. We wanted to interrogate the link between baseline myeloid elements in circulation, bone marrow blasts, and BCR-ABL values with clinical manifestations. Methods: Patients attending the Glivec International Patient Assistance Clinic at the Nairobi Hospital had records prospectively collected, and analyzed. These included demographic profiles, physical examination, and laboratory values. Absolute, range, median and mean counts for wbcs, absolute neutrophil counts (ANC), platelets, haemoglobin and BCR-ABL values, were tested against each of the clinical presentations. Results: There were 583 patients, males 322 (55.2%) and females 261 (44.8); mean age 39.8 years. Commonest symptom was abdominal swelling in 235 cases (40.3%); 70 (12%) experienced abdominal pain. Priapism occurred in 4 males (1.2%), blindness and deafness in 8 patients (1.4%). Splenomegaly was more common among males than females; [Pearson Chi2 (1) = 5.9545, ( Pr = 0.015)]. Patients aged ≤ 20 years were more likely to be in heart failure, [Pearson Chi2 (3) = 8.8255,( Pr = 0.032)], leg swelling more in those with high platelet counts; [Ranksum test, (p = 0.023)]. Unclear presentation was more common in those with high wbc counts; [Ranksum test, (p = 0.015)]. Total wbc counts and BCR-ABL levels were higher among younger patients; [Kruskal-Wallis test (p = 0.036, and 0.025 respectively)]. Patients with leg swelling had lower BCR-ABL levels; [Ranksum test (p = 0.005)], those in heart failure had significantly higher BCR-ABL levels at baseline compared with the rest; [Ranksum test (p = 0.037)]. Patients with lymphadenopathy were more likely to have lower ANCs; [Ranksum test (p = 0.035)]. Conclusions: Clinical manifestations of CML cannot be explained merely by haematologic values. Complex biologic factors should be interrogated further.

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DENGUE FEVER;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2127 ◽

2014 ◽

Vol 21 (03) ◽

Author(s):

Khalida Shaikh ◽

Khalida Naz Memon ◽

Bibi Sarah ◽

Rasheed Akhtar ◽

Manzoor Memon ◽

...

Keyword(s):

Risk Factors ◽

Dengue Fever ◽

Reporting Rate ◽

Preventive Interventions ◽

Asian Countries ◽

Clinical Presentations ◽

Younger Age ◽

Hemorrhagic Tendency ◽

The Mean ◽

Gender Specific

Background: Dengue fever & its complications have become a nightmare forcommon people in Asian countries including Pakistan. Besides environmental factorsresponsible for its transmission, there are many host factors too involved in its rapid spread.Objective: To assess risk factors for dengue fever among patients reporting at Liaquat UniversityHospital (LUH) Hyderabad. Study Design, Setting & Study duration: Descriptive crosssectional study was conducted at LUH, Hyderabad for six months i.e. from 15th May 2013 to 15thNovember 2013. Methods: 481 patients were registered through convenient sampling afterinformed verbal consent. Patients’ demographic features, clinical presentations & laboratoryreports were collected on a preformed proforma. Results: The reporting rate for dengue feverwas 18.5% & the mean age of presentation was 28.5 ± 3.5 years. Males were in majority (72.55%)3 & the average days of admission were 4.5 days; low platelets count (< 50,000/mm ) wasrecorded in 72% of cases; however 11.64% patients presented with hemorrhagic tendency. Agewas strongly associated with thrombocytopenia (p=0.04) & with occurrence of hemorrhage(p=0.03) in both genders; this association was more evident among males (p=0.01). Howeveramong uncomplicated cases no association was evident between gender & length of stay in(p=0.35). Conclusions: The alarmingly higher reporting rate of dengue fever necessitatescontextual preventive interventions. As younger age & male gender are the major risk factors forthis disease; therefore age-specific & gender-specific preventive strategies against this diseaseare recommended.

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Bilateral acute visual loss from Rathke’s cleft cyst apoplexy in a patient with dengue fever

Arquivos Brasileiros de Oftalmologia ◽

10.5935/0004-2749.20140083 ◽

2014 ◽

Vol 77 (5) ◽

Author(s):

Ana Cláudia De Franco Suzuki ◽

Rafael Barbosa de Araújo ◽

Eduardo Cunha de Souza ◽

Mário Luiz Ribeiro Monteiro

Keyword(s):

Dengue Fever ◽

Visual Loss ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Acute Visual Loss ◽

Rathke's Cleft

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Clinico-epidemiologic characteristics of the 2019 dengue outbreak in Bangladesh

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa126 ◽

2020 ◽

Author(s):

Mohammad Jahid Hasan ◽

Tamanna Tabassum ◽

Mohiuddin Sharif ◽

Mohammad Abdullah Saeed Khan ◽

Akhi Roy Bipasha ◽

...

Keyword(s):

Dengue Fever ◽

Tertiary Care ◽

Clinical Findings ◽

Immunoglobulin M ◽

Laboratory Findings ◽

Case Record ◽

Medical College ◽

Dengue Outbreak ◽

Clinical Presentations ◽

Pain Symptoms

Abstract Background Dengue fever shows a broad range of clinical presentations worldwide. Here we report on our clinical findings during the 2019 dengue outbreak in one of the largest tertiary care hospitals in Dhaka, the capital of Bangladesh. Methods A total of 747 suspected dengue cases (553 confirmed and 194 probable) were interviewed with a pro forma case record form. Statistical analyses were conducted using SPSS 20.0. Ethical clearance was obtained from the Dhaka Medical College. Results The mean age of the dengue cases was 27 y and approximately two-thirds were male. Positive tests for NS1 and anti-dengue immunoglobulin M antibody were present in 91.9% and 59.4% of the cases, respectively. Thrombocytopenia was present in 69% of cases and fever was present in 99.1% of cases. Gastrointestinal (GI) features, including anorexia and/or vomiting (69.4%), abdominal pain (39.8%) and diarrhoea (25.6%), were more prevalent than typical rash and pain symptoms. Hypotension was present in approximately one-quarter of patients (25.4%). Probable and confirmed dengue cases have shown similar clinical characteristics and laboratory findings. Conclusions The 2019 outbreak of dengue fever in Bangladesh was characterized by increased presentation with GI features. Recognition of this trend would permit early diagnosis and proper management of patients.

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Persistent visual loss in dengue fever due to outer retinal damage

Clinical and Experimental Ophthalmology ◽

10.1111/ceo.12960 ◽

2017 ◽

Vol 45 (7) ◽

pp. 747-749 ◽

Cited By ~ 4

Author(s):

Petra P Fang ◽

Maximilian Pfau ◽

Frank G Holz ◽

Robert P Finger

Keyword(s):

Dengue Fever ◽

Visual Loss ◽

Retinal Damage

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Visual electrophysiology in the assessment of toxicity and deficiency states affecting the visual system

Eye ◽

10.1038/s41433-021-01663-2 ◽

2021 ◽

Author(s):

Emily K. O’Neill ◽

Richard Smith

Keyword(s):

Visual Loss ◽

Structural Changes ◽

Vitamin A Deficiency ◽

Objective Assessment ◽

Visual Disturbance ◽

Micronutrient Deficiency ◽

Clinical Presentations ◽

Ocular Imaging ◽

Visual Electrophysiology ◽

Visual Failure

AbstractVisual disturbance or visual failure due to toxicity of an ingested substance or a severe nutritional deficiency can present significant challenges for diagnosis and management, for instance, where an adverse reaction to a prescribed medicine is suspected. Objective assessment of visual function is important, particularly where structural changes in the retina or optic nerve have not yet occurred, as there may be a window of opportunity to mitigate or reverse visual loss. This paper reviews a number of clinical presentations where visual electrophysiological assessment has an important role in early diagnosis or management alongside clinical assessment and ocular imaging modalities. We highlight the importance of vitamin A deficiency as an easily detected marker for severe combined micronutrient deficiency.

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A tourist with dengue fever and visual loss

The Lancet ◽

10.1016/s0140-6736(02)11145-7 ◽

2002 ◽

Vol 360 (9339) ◽

pp. 1070 ◽

Cited By ~ 44

Author(s):

Christos Haritoglou ◽

Sarah D Dotse ◽

Günther Rudolph ◽

CM Stephan ◽

SR Thurau ◽

...

Keyword(s):

Dengue Fever ◽

Visual Loss

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Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.sepoct02 ◽

2003 ◽

Vol 8 (5) ◽

pp. 4-12

Author(s):

Lorne Direnfeld ◽

James Talmage ◽

Christopher Brigham

Keyword(s):

Upper Extremity ◽

Radicular Pain ◽

Illness Behavior ◽

Orthopedic Surgeon ◽

First Case ◽

Clinical Presentations ◽

Whole Person ◽

Physical Examinations ◽

Upper Extremity Impairment ◽

The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

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