European Journal of Cardiovascular Medicine

Background: The platelet count declines and petechiae appear in widespread distribution with spontaneous ecchymoses. Bleeding occurs at mucosal surfaces from the gastrointestinal tract and at venipuncture sites. Objective: to study Correlation between the laboratory features – thrombocytopenia, elevated hepatic enzymes, hyponatremia, high hematocrit and severity of dengue infection. Methods: It is an observational study conducted at a multispeciality teaching Hospital. The study population (cohort) was selected from the hospital inpatients who are admitted in paediatric intensive care unit as well as paediatric ward

Background: Low blood platelet counts are a defining characteristic of the illness known as thrombocytopenia. It is the most typical haematological aberration observed in people with chronic liver disease.1 It has been documented in 64%–84% of individuals with various aetiologies of liver cirrhosis or fibrosis.2 Thrombocytopenia has been regarded as one of the key signs of advanced liver disorders as a result. OBJECTIVES: 1. Identifying the correlation of platelet count, spleen size, and their ratio with the presence of esophageal varices in patients with liver cirrhosis without any previous evidence of GI bleeding. 2. Assessing the ability of these parameters as non-invasive tools to predict the presence of esophageal varices. MATERIAL & METHODS:  Study Design: Prospective Observational study. Study area: Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatient. Study Period: January 2019 to December 2020. Study population: Liver cirrhotic Patients attending Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatients. Sample size: Study consisted a total of 50 subjects. Sampling Technique: Simple random technique. Study tools and Data collection procedure: In this prospective observational study of 50 patients, newly diagnosed patients with liver cirrhosis without a history of gastrointestinal bleeding were included. Relevant clinical parameters were assessed, which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of spleen long axis diameter. Platelet count/ spleen diameter ratio were calculated for all patients. Results: Patients were grouped according to Child-Pugh Classification of Cirrhosis. Majority of study group patients belonged to Child-Pugh class C (66.00%) followed with class B (30.00%). Majority of patients belonged to the category of ratio between 501-1000 (48.00%) followed with<500 (24.00%), 1001-2000 (20.00%) and >2000 (8.00%). CONCLUSION: we conclude that the incidence of thrombocytopenia and lower PC/SD ratio can be used to establish higher grades of varices. It can be used to identify the subset of patients requiring endoscopy for prophylactic management of esophageal varices. It may further reduce the burden on the endoscopy units, avoid unnecessary screening endoscopies and management costs for bleeding varices.

Introduction: Even before the culture reports are obtained, hematological alterations in sepsis can help in the early diagnosis of sepsis. One of the most common issues with neonatal sepsis is thrombocytopenia, which is also one of the most reliable independent risk factors for sepsis-related mortality. The purpose of the current study was to figure out the incidence of thrombocytopenia in newborn sepsis and to assess if it might be used as a screening test for the condition. Materials and methods: The Neonatal Intensive Care Unit at a tertiary care hospital hosted this hospital-based prospective observational cross sectional study from July 2022 to December 2022. In total, 220 neonates who were hospitalized to the NICU with suspected sepsis before turning 28 days old were included in the study. Results:  A total of 220 newborns with clinical sepsis were admitted during the research period. There included 73 (33.18%) female neonates and 147 (66.82%) male neonates. In 56 (25.4%) patients, the blood culture proved positive. The most prevalent Gram positive and Gram negative organisms were Kleibsella species 13 (23.21%) and coagulase negative Staphylococci (CONS) 23 (41.07%). 101 births (45.91%) by caesarean section and 119 (54.09%) by normal vaginal delivery were recorded. 43 neonates (19.55%) had low birth weights, while 177 had normal birth weights (>2.5 kg). SGA made up 33 (15%), AGA made up 183 (83.18%), while LGA made up 4 (1.82%). Preterm births made up 42 (19.09%), term births made up 168 (76.36%), while postterm births made up 10 (4.55%) cases. CRP was positive in 123 instances (55.91%) and negative in 97 cases (44.09%). Among the total cases, 89 (40. 45%) had thrombocytopenia, in which mild was 53 (24.09%), moderate was 28 (12.73%), severe was 8 (3.64%). Thrombocytopenia was significantly associated with Blood culture positivity, LSCS, SGA and CRP positivity. (P<0.05) Conclusion: Thrombocytopenia acts as an early predictor of neonatal sepsis and also the outcome of the neonates. Platelet counts and clinical correlation can be used in conjunction to detect early sepsis and administer prompt, effective care

Aims and Objective- To study the prevalence of coagulation abnormalities associated with Intrauterine fetal death. Materials and Method-The study was conducted in Obst &gynec Dept, Tertiary care hospital, Southern Odisha in a study period Aug-2020 to Oct 2022. A detailed clinical history, demographic parameters, causes of IUFD, associated complications and examination findings will be recorded as per the proforma and the following investigations will be done in each case: CBC to ascertain thrombocytopenia, Prothrombin time(PT), Activated partial thromboplastin time(aPTT),D-Dimer ,Fibrinogen assay,Modified ISTH score taken consisting of  platelet count, PT and fibrinogen level. Results - Out of the total 116 cases of IUFD, 18 cases were clinically diagnosed with DIC; Prevalence is 15.5% in our study. The mean age of study participants was 25.10 ±6.30 years which ranged from 18 to 37 years. Majority of the cases were primigravida and presented at preterm. Apart from the undiagnosed cases, which was the major part ,from the rest of the cases PIH and Abruptio constituted the major proportion of identifiable causes of IUFD. PIH, Abruptio and HELLP syndrome were the major obstetrical complications contributing to clinical DIC as well as those at risk of developing subsequent DIC which was found to be statistically significant. The sensitivity was found to be more in pregnancy modified ISTH score --(83.3%) compare to ISTH overt score (50%). The specificity was found to be more in ISTH overt score (96.9%) compare to pregnancy modified ISTH score (78.5%) Conclusion- in obstetrics is a life-threatening complication that is secondary to obstetrical and non-obstetrical related complications of pregnancy. It is associated with high maternal and perinatal morbidity and mortality. The present study was conducted to determine the risk of DIC in the cases of IUFD.It is recommended that coagulation studies should be considered in IUFD specially when complicated by PIH. abruption or severe complications such as HELLP syndrome. However, our study is of small sample size (116) requires large studies meta analysis

Background:   To assess etiological factors, severity, complications and mortality due to thrombocytopenia in commonly encountered infections in hospitalised patients of MDM Hospital, DR S N Medical College, Jodhpur during 2021and 2022. Material and Methods: This was a hospital based, observational descriptive study of 310 patients presenting with thrombocytopenia due to infective etiology. Observations and Results: Dengue fever (50.9%) was found to be the most common cause of thrombocytopenia followed by malaria (17.1%), scrub typhus (16.1%), HIV (4.5%), sepsis (2.9%) and enteric fever (2.6%). Very severe thrombocytopenia (<20,000/µl) was seen in 23.2% patients, 47.1% had severe thrombocytopenia (20,000-50,000/µl), 25.8% patients had moderate thrombocytopenia (51,000-1,00,000/µl) and Mild thrombocytopenia (1,00,000-1,50,000/µl) was seen in 3.9% patients. 50.3% patients presented with bleeding manifestations of which petechial rash (15.5%) was the most common. Overall mortality was 3.5% which was higher in patients with Very severe thrombocytopenia, patients of P. falciparum malaria, scrub typhus and those having concomitant infections. Conclusion: Pyrexia with thrombocytopenia is the most commonly encountered condition with myriad connotations. It is important to find out the cause of the thrombocytopenia. Finding etiological diagnosis early is reassuring and rewarding.

In tropical and subtropical regions of the world, dengue fever is an arboviral public health emergency that affects a sizable endemic population and presents with differing degrees of clinical manifestation. This investigation looked at the dynamics of the four dengue serotypes in the laboratory and hospitals. Methods: This hospital-based observational study involved 100 inpatients with dengue infection who were over 12 years old, free of co-morbidities, and had no known malignancy at a tertiary care facility. Results: Four of the 100 patients had two serotypes of infection simultaneously. Dengue virus serotype-2 (DENV 2) was found in 34% of cases and accounted for the highest number of cases of severe dengue (20.6%). There was no difference in the mean total leukocyte count between the serotypes. With a greater percentage of cases of severe dengue (20% vs. 14.3%, nonsignificant), DENV 4 had a substantially higher mean neutrophil percentage and a significantly lower mean lymphocyte percentage than DENV 1 (p-value 0.001 and 0.02, respectively). Thrombocytopenia was observed in every infection serotype. When comparing DENV 2, 3, and 4 to DENV 1, there was a noticeable difference in the impairment of liver function. Infections with DENV 3 and 4 were associated with considerably reduced mean serum albumin levels. Co-infection cases showed lower mean serum albumin and a substantially greater deviation in liver function than infections with a single serotype. Both the mean blood creatinine and urea levels were within the normal limit for all serotypes. In our study, there was no death. Conclusion: In our hospital, the most prevalent serotype with the highest severity is DENV 2. Severe dengue cases are prevalent in DENV 2 and DENV 4, with rates of 20.6% and 20%, respectively. In DENV 4, there was a greater degree of hepatic involvement and hypoalbuminemia, but the mean lymphocyte percentage was much lower. Initial serotyping in dengue patients can be used to 
determine the clinical and laboratory trends of the various dengue infection serotypes as well as to track epidemiological trends. Patients who have co-infections require special attention. 

Background: In tropical countries like India, thrombocytopenia is commonly encountered by clinicians in any speciality. Thrombocytopenia present as asymptomatic condition to sometimes becomes a life-threatening condition requiring blood transfusion in various etiological conditions. Infections like malaria and dengue are invariably associated to thrombocytopenia with changing trends in clinical features. Infection is the commonest cause of thrombocytopenia. The objective of study was to evaluate the different causes of thrombocytopenia along with study of clinical profile and laboratory parameters in patients with thrombocytopenia. Methods: A cross-sectional hospital based study was conducted in Department of Medicine at Tertiary Care Hospital from April 2019 to October 2019. This study comprises cases of thrombocytopenia of age more than 14 years admitted with platelet count <1 lack/mm3, whereas patients with already diagnosed with causes associated with thrombocytopenia such as malignancy and chemotherapy induced thrombocytopenia, idiopathic thrombocytopenic purpura, cirrhosis of liver were excluded. Results: Study shows almost 46.6 % of total patients were below age of 30 years and 53.4% patients were above 30 years of age. The highest incidence of thrombocytopenia was seen in the age group of 21-30 years (26.6%), followed by 31-40 (25.8%) and 12-20 years (20%). The most common diseases that causes thrombocytopenia were infections (65.80%) [i.e. Dengue (31.67%), Malaria (25.0%), Enteric fever (3.33%), HIV (0.8%), and DIC (5.0%)]. Megaloblastic anaemia (18.33%) were common in younger population. Conclusion: Study concluded that most common causes of thrombocytopenia were infections (65.8%) and megaloblastic anemia (18.33%). Bleeding manifestations were present in 28.33% of patients and the most common site of bleeding was skin and mucous membrane. The main etiological cause of bleeding in this study was dengue hemorrhagic fever followed by malaria and megaloblastic anaemia

Background: Platelets are quintessential for primary hemostasis. Platelet counts are measured by automatic cell counters which work on the basis of electrical impedance, optical and fluorescent methods using the size, refractive index and nucleic acid stain. Ethylene diamine tetra acetic acid (EDTA) is commonest used anticoagulant for haematological investigations. This can very rarely lead to a spuriously low platelet count called EDTA induced pseudothrombocytopenia (PTCP). PTCP is an in-vitro problem and low platelet count can be alarming to the patient and clinician. It may lead to the use of unnecessary treatments and diagnostic procedures, such as platelet transfusions, bone marrow aspiration and biopsy, and sometimes long-term steroid therapy or even splenectomy. However, it is not associated with bleeding symptoms or platelet dysfunction. 1-3. This is a cross-sectional prospective study of 5600 cases related to platelet count in 3 years from 2021-2024 in a private diagnostic centre in Mandya, Karnataka. Among these, 12 cases of EDTA induced thrombocytopenia were observed. The female to male ratio was 3:1. The median age was 37 ± 14.08 years. All cases showed thrombocytopenia on cell -counters. There was no clinical suspicion of thrombocytopenia in these patients. PTCP leads to more pronounced thrombocytopenia even in mild cases of thrombocytopenia. History and clinical examination of the patients revealed no underlying clinical condition like common viral infections, steroid or chemotherapy that would have caused thrombocytopenia.  

Aim and Objective: To describe the epidemiology, clinical-serological profile, and outcome of primary APS in a South Indian tertiary care center. Material and methods: This retrospective study, conducted in the Clinical Immunology and Rheumatology Department at SRMC/SRIHER Chennai from 2018 to 2024, included 40 patients with the primary anti-phospholipid syndrome (PAPS) as defined by the modified Sapporo criteria. Patients with conditions like protein C or S deficiency, hyperhomocysteinemia, Factor V Leiden mutation, or other autoimmune diseases were excluded. Data on demographics, clinical presentation, lab results, and treatment outcomes were gathered. Anticardiolipin (aCL) and anti-β-2 glycoprotein I (β-2GPI) antibodies (IgG and IgM) were measured by ELISA, with positivity cut-offs of 12 GPL-U/ml for aCL and 20 GPL-U/ml for β-2GPI. Lupus anticoagulant (LAC) was assessed using the diluted Russell Viper Venom Test (dRVVT), with a normalized ratio >1.2 indicating positivity. This approach ensured standardized PAPS diagnosis and characterization in the study cohort. Result: In this study of 40 primary anti-phospholipid syndrome (PAPS) patients, 82.5% were female, with an average diagnostic age of 35.9 years (range 16–65). Venous thrombosis was the most frequent presentation, seen in 60% of cases, followed by arterial thrombosis (37.5%) and mixed thrombosis (22.5%), while 12.5% had obstetric complications. Deep vein thrombosis (DVT) and ischemic stroke were the most prevalent venous and arterial events, at 47.5% and 27.5%, respectively. Diagnostic testing revealed lupus anticoagulant (LAC) in 55% of patients, anti-β-2 glycoprotein I (β-2GPI) in 47.5%, and anticardiolipin (aCL) antibodies in 37.5%; 20% were positive for all three antibodies. Non-thrombotic manifestations included thrombocytopenia (27.5%) and hemolytic anemia (22.5%). Catastrophic anti-phospholipid syndrome (CAPS) affected 12.5% of patients, with one fatality, while 12.5% experienced thrombosis recurrence. Conclusion: Data on primary anti-phospholipid syndrome (PAPS) alone is limited, as most studies combine primary and secondary APS cases. Our study uniquely focuses on PAPS, including cases with catastrophic APS (CAPS), where triple-positive APS antibodies were more prevalent. Venous thrombosis was the most common presentation, with LAC as the leading antibody, followed by β2GPI and aCL, while thrombotic microangiopathy (TMA), frequently observed in our study, is rarely reported elsewhere.

Background: Community-Acquired Pneumonia (CAP) is the leading cause of death in children under 5 years of age according to WHO. Platelets have been recognized as an important component of an immune response. Thrombocytopenia is a prognostic indicator of pneumonia according to different studies Methods: A Retrospective observational study was conducted in the Department of Paediatrics in the tertiary care teaching hospital in Karwar from April 2021 to April 2023 for a period of 24 months to determine the association of abnormal platelet count with complications, TLC, CRP and duration of hospital stay in under 5 children with CAP. Results: A total of 150 children were included in the study. Majority were between 3-5 years (58%) of age and males (58%). 24.7% were diagnosed to have severe pneumonia. Both thrombocytopenia and thrombocytosis showed significant association with development of systemic complications. Weak association was found between platelet count and TLC but no significant association observed between platelet count with CRP and duration of hospital stay.  Conclusion: Abnormal platelet count can be considered as a prognostic indicator in CAP among children of under 5 years age. 

Background: Platelet indices, including platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), have been reported to be altered in various hematological and non-hematological disorders. This study aimed to analyze platelet indices in different hematological and non-hematological disorders in a tertiary care institute in northern India. Methods: A total of 1701 cases, including 1317 (77.4%) hematological disorders and 384 (22.6%) non-hematological disorders, were analyzed retrospectively. Platelet indices were compared between hematological and non-hematological disorders and among different hematological disorders using appropriate statistical tests. Correlations between platelet indices and age, hemoglobin, and white blood cell (WBC) count were also assessed. Results: Hematological disorders had significantly higher PC (268.4 ± 107.4 × 10⁹/L vs. 245.7 ± 98.3 × 10⁹/L, p = 0.001), MPV (10.5 ± 1.7 fL vs. 10.2 ± 1.6 fL, p = 0.003), PDW (15.5 ± 2.4% vs. 15.1 ± 2.4%, p = 0.007), and PCT (0.28 ± 0.11% vs. 0.25 ± 0.10%, p < 0.001) compared to non-hematological disorders. Among anemia subtypes, macrocytic anemia had the lowest PC and the highest MPV and PDW (p < 0.001). Thrombocytosis had a higher PC and PCT and lower MPV and PDW compared to thrombocytopenia (p < 0.001). Age, hemoglobin, and WBC count showed significant correlations with platelet indices (p < 0.05). Conclusion: Platelet indices differ significantly between hematological and non-hematological disorders and among various hematological disorders. The findings highlight the potential utility of platelet indices as diagnostic and prognostic markers in these disorders. Further studies are needed to validate their clinical significance and establish their role in disease management.

Background: Introduction-The CNS is the most important site of infection in patients with rickettsial diseases. Patients with scrub typhus have mild-to-moderate neurological manifestations. Meningitis and encephalitis are the most common neurological manifestations. Aim: Study of clnicopathological and biochemical profile in scrub encephalitis. Materials and Methods:  Hospital based observational study conducted at Medicine department of SMS Hospital, Jaipur from January 2023 to June 2024 on 30 patients of Scrub Encephalitis. Results:  In present study out of 30 patients 12 have seizures, neck rigidity was seen in 28 cases and Kernig sign was seen in 12 cases. Altered sensorium was seen in 69% of our patients.In present study most common MRI brain finding seen were Increased Signal intensity in various parts of brain and acute infarct. Conclusion: Scrub Encephalitis is an important diagnosis to be made in any patient with altered sensorium, as it is eminently treatable. Clinical clues such as eschar, and investigations showing altered liver function tests and thrombocytopenia, may point to this diagnosis as shown in our study. Prompt therapy can be lifesaving, and hence, this is an important diagnosis to be made in tropical countries.

Background: Thrombocytopenia in adults is a common condition frequently encountered in day care and indoor patients. Its etiology can be various conditions. Clinical manifestations can be subtle to life threatening. Hence determining the exact cause of thrombocytopenia is necessary to prevent any untoward outcome. Materials and Methods: The present study attempts to determine the various causes of thrombocytopenia in adults by collecting data from 120 patients from July 2022 to December 2022. Final diagnosis was made by complete blood count, manual platelet count by peripheral blood smear, malarial parasite antigen, Widal test, dengue serology, Coombs test, abdominal ultrasound. Result: The most common cause of thrombocytopenia in adults was found to be malaria (27.5%) followed by dengue (25%) and megaloblastic anemia (20%). The other causes were found to be leukemia (14.2%), septicemia (3.3%), chronic liver disease (2.5%), enteric fever (2.5%), aplastic anemia (1.7%), hypersplenism (1.7%), myelofibrosis (0.8%) and drug induced (0.8%). Conclusion: Our study found that malaria and dengue were the most common causes of thrombocytopenia both of which are caused due to mosquitoes. Megaloblastic anemia was the third most common cause, which is most commonly caused by due to nutritional deficiency of vitamin B12 and folate. All these causes are potentially preventable.

Background: Transfusion of blood and its products is one of the important pillars in the treatment of patient in Emergency Department. Methods: The study is Cross Sectional study over a period of 12 months from March 2021 to February 2022. A total of 348 cases were assessed from Emergency Department (Casualty) of SAIMS Hospital, Indore. Results: Out of 348 cases,most common indication for transfusion was massive blood loss due to roadside accident in 167(47.98%) patients, followed by heart disease patient on antiplatelet medication in 128(36.78%) patients followed by Hemato-oncological disease patients 31(8.9%) and then patients with chronic anemia 22 (6.33%).180(51.72%)patients received RCC transfusion, 105(30.17%)patients received platelet transfusion and 63(18.10%)patients received FFP transfusion. The most common indication for RCC transfusion was Anaemia due to massive blood loss, for PC transfusion was Thrombocytopenia due to Heart failure and DIC and for FFP is Hypoproteinemia. Transfusion was done in patients with Hb <7g/dl even if they had no co-morbidities. Patients with co-morbidities transfused at Hb between 7-10g/dl. 267(76.72%) patients had a pre-transfusion Hb of 5-7g/dl, 73(20.97%) patients had pre-transfusion Hb of 8-10 g/dl and 8(2.29%) patients had a Hb of 11-12 g/dl. Most of the patients Post Transfusion Hb were around 11-12 g/dl. When patients pre-transfusion Hb was 5-7 g/dl, 3-4 units of RCC transfused and when it was 8 -10 g/dl,2-3 units of RCC transfused. Conclusion: For better utilisation and to reduce wastage of blood and blood products, a protocol has to be formulated.

Background: Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Objective: To assess the bleeding and cardiovascular outcomes associated with DAPT in patients with varying degrees of baseline thrombocytopenia undergoing PCI. Methods: A prospective cohort study was conducted at a tertiary care hospital, enrolling 368 patients with thrombocytopenia undergoing PCI. Patients were stratified into mild (100,000– 150,000/mm³), moderate (50,000–100,000/mm³), and severe (30,000–50,000/mm³) thrombocytopenia. Outcomes included bleeding complications (BARC criteria), major adverse cardiovascular events (MACE), in-hospital mortality, and post-PCI complications. Univariate and multivariate models were used for analysis. Results: Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion: Moderate and severe thrombocytopenia are independent predictors of bleeding and cardiovascular events in patients on DAPT post-PCI. These findings emphasize the need for stratified management in this high-risk group. 

Background Thrombocytopenia, defined as a platelet count below 150,000/cmm, is a frequent hematological condition with potentially life-threatening consequences. It can result from either hyperdestructive thrombocytopenia (increased platelet breakdown) or hypoproductive thrombocytopenia (decreased platelet production). Bone marrow examination is the gold standard for differentiating these causes, but it is invasive. Recent advances in automated hematology analyzers have enabled the measurement of platelet indices such as MPV (Mean Platelet Volume), PDW (Platelet Distribution Width), and P-LCR (Platelet Large Cell Ratio), which may help in distinguishing thrombocytopenia subtypes in a non-invasive manner. Methods This prospective cross-sectional study included 80 thrombocytopenic patients, classified into two groups: 49 with hypoproductive thrombocytopenia and 31 with hyperdestructive thrombocytopenia. Additionally, 20 age- and sex-matched healthy individuals served as a control group. All patients underwent clinical evaluation, CBC (Complete Blood Count) analysis using an automated hematology analyzer (Sysmex XN-1000), peripheral smear examination, and bone marrow aspiration where necessary. Platelet indices (MPV, PDW, and P-LCR) were measured and correlated with the underlying cause of thrombocytopenia. Results Statistical analysis showed significant differences in platelet indices between the two groups. Patients with hyperdestructive thrombocytopenia (e.g., Immune Thrombocytopenic Purpura) had significantly higher MPV, PDW, and P-LCR compared to those with hypoproductive thrombocytopenia. ROC (Receiver Operating Characteristic) curve analysis established cutoff values for these indices, which demonstrated good sensitivity and specificity in differentiating thrombocytopenia subtypes. A strong correlation was observed between MPV and PDW in both groups. Conclusion Platelet indices, particularly MPV, PDW, and P-LCR, provide valuable insights into the etiology of thrombocytopenia. These indices can serve as reliable, cost-effective, and non-invasive alternatives to bone marrow examination for differentiating hypoproductive from hyperdestructive thrombocytopenia. Their routine use in clinical practice may improve diagnostic accuracy and patient management, reducing the need for invasive procedures

Background: Dengue fever, caused by the dengue virus (DENV) and transmitted by Aedes aegypti mosquitoes, is a rapidly growing public health concern, particularly in tropical regions like India. The disease exhibits a wide clinical spectrum from mild febrile illness to severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Early identification of hematological abnormalities is crucial for effective diagnosis, risk stratification, and timely intervention. This study aimed to evaluate the clinical and haematological profiles of patients with acute dengue infection and examine the correlation between laboratory parameters and disease severity. Materials and Methods: This hospital-based observational study was conducted at Anugrah Narayan Magadh Medical College, Gaya from July 2018 to March 2020. A total of 280 patients with serologically confirmed dengue (NS1 antigen and/or IgM antibody positive) were included. Demographic, clinical, and haematological data were recorded. Complete blood counts were analyzed using an automated hematology analyzer, and serial monitoring was performed in severe cases. Dengue severity was categorized as Dengue Fever (DF), DHF, or DSS based on WHO criteria. Statistical analysis was conducted using standard software, with p<0.05 considered significant. Results: The mean age of patients was 33.8 ± 14.5 years, with a predominance of young adults (18–40 years, 50%) and males (60%). Urban residents accounted for 70% of cases. Common clinical features included fever (100%), myalgia (80%), and headache (70%), with bleeding manifestations present in 30% of patients. Thrombocytopenia (<150,000/µL) and leukopenia (<4,000/µL) were observed in 82% and 58% of patients, respectively. Elevated hematocrit (>40%) was seen in 46%. Significant trends were noted across severity groups, with DSS patients showing the lowest platelet counts (mean 32,000/µL) and highest hematocrit (mean 46.0%; p<0.001). Serial monitoring showed platelet recovery by Day 7 in most severe cases. Patients with bleeding had significantly lower platelet counts and higher hematocrit compared to those without bleeding (p<0.001). Conclusion: Thrombocytopenia, hemoconcentration, and leukopenia are prominent haematological markers in dengue and are strongly associated with disease severity and bleeding risk. Routine monitoring of these parameters can guide early diagnosis, clinical management, and risk stratification. This study emphasizes the importance of localized data in shaping regional dengue control strategies and reinforces the value of simple haematological tests in the effective management of dengue, especially in resource-limited settings.

Background and Aim: Febrile thrombocytopenia is a common presentation in tropical regions and may involve subclinical cardiac complications. Early detection of these abnormalities is crucial for timely intervention. the present study was undertaken to evaluate cardiac abnormalities in adult patients with febrile thrombocytopenia using handheld 2-D echocardiography in a tertiary care institute in India. Material and Methods: A prospective observational study was conducted on 100 adult patients admitted with febrile thrombocytopenia to a tertiary care hospital in India from January to December 2023. Bedside 2-D echocardiography was performed within 24 hours of admission to assess cardiac function. Results: Cardiac symptoms were present in 19% of patients, while echocardiographic abnormalities such as pericardial effusion and myocarditis were observed in 22% and 4%, respectively. Cardiac involvement was more frequent in patients with Dengue Shock Syndrome compared to those with Dengue Hemorrhagic Fever. Conclusion: Bedside 2-D echocardiography is an effective tool for early detection of cardiac abnormalities in febrile thrombocytopenia. Its routine use could enhance clinical management, especially in resource-limited settings.

Microcytosis is a condition in which red blood cells are measured by their mean corpuscular volume 2. Microcytosis is characteristics of Iron deficiency anemia.1 Both Thrombocytosis and thrombocytopenia may be seen in severe microcytosis although thrombocytosis is more commonly seen.  Aim and Objectives:  To study the values of impedance platelet count and mean platelet volume in case of severe microcytosis.  Materials and Method: A prospective study of 150 cases was carried out from 1st July 2018 to 31st October 2018 in Department of Pathology. Study of platelet count and mean platelet volume of 150 cases with low mean corpuscular volume (MCV) was done.  Results: A total 150 cases with severe microcytosis (MCV < 60 fl) were evaluated for platelet count and mean platelet volume. Thrombocytosis was seen in 85 cases(56.7%), thrombocytopenia in 15 cases(10%), whereas normal platelet count was seen in 50 cases(33.3%). The mean platelet volume was low in 75 cases(50%) , high in 10 cases(6.7%), normal in 65 cases(43.3).  Conclusion: In severe microcytosis, both thrombocytosis and thrombocytopenia may occur although the incidence of thrombocytosis was high in our study. There is an inverse relationship of mean platelet volume and platelet count in case of severe microcytosis.

D-transposition of great arteries (D-TGA) is one of the most common cyanotic congenital heart diseases diagnosed at birth. The pathophysiology of D-TGA is ventriculoarterial discordance leading to parallel circulation. The survival of the neonate depends on the intercirculatory mixing of oxygenated and deoxygenated blood at various levels through atrial septal defect, ventricular septal defect or patent ductus arteriosus. Few patients survive beyond the first year of life. A case of D-TGA with ventricular septal defect and left ventricular outflow obstruction survived till six years of age and underwent successful arterial switch operation. Arterial switch operation (ASO) was performed as it was substantiated by echocardiographic and angiographic findings. The patient’s perioperative course was uneventful and was discharged on the 8^th postoperative day. The present case, which is one of the advanced ages at which arterial switch operation for TGA/Ventricular Septal Defect/Left Ventricular Outflow Tract Obstruction was performed among previously reported cases, is used to discuss late Arterial Switch Operation and its anaesthetic management in this case report.

Background: Dengue fever is a widespread mosquito-borne viral illness that poses a significant global health challenge. While primarily self-limiting, it can progress to severe forms such as dengue hemorrhagic fever and dengue shock syndrome. Hepatic dysfunction is a frequently observed complication, present in up to 90% of hospitalized cases, and may serve as an early prognostic marker for disease severity. Methods: This prospective observational study included 100 adult patients (≥18 years) with laboratory-confirmed dengue fever at a tertiary care center in central India over six months. Clinical presentation, liver function tests (AST, ALT, bilirubin, albumin), hematological parameters (WBC, platelet count, hematocrit), and ultrasound findings were recorded. Hepatic involvement was defined as elevated transaminases (>2× upper limit of normal), hyperbilirubinemia, or clinical signs of liver dysfunction. Patients were stratified by severity using WHO dengue classification criteria. Results: Elevated AST and ALT levels were noted in 88% and 81% of patients, respectively, with AST predominance. Hepatomegaly was seen in 26%, and jaundice in 8% of cases. Thrombocytopenia (91%) and leukopenia (76%) were prevalent hematological abnormalities. According to WHO criteria, 12% developed severe dengue, while 42% had warning signs. Elevated transaminases and low platelet counts showed significant correlation with severe disease. Conclusion: Hepatic dysfunction is a common and early feature in dengue infection, with elevated transaminases—particularly AST—and thrombocytopenia serving as key indicators of severity. Early identification of these abnormalities can facilitate risk stratification and timely intervention, potentially improving clinical outcomes.

Background: This case report describes a rare instance of coinfection with leptospirosis and scrub typhus in a previously healthy 23-year-old male sales worker from a middle-class family in North-eastern India. The patient presented with a seven-day history of high-grade fever with altered kidney and liver function as evidenced by rise of blood parameters accompanied by severe headache. Initial symptomatic management failed due to persistent fever and onset of hypotension, prompting referral to a tertiary care institute. Clinical Findings: Upon evaluation, investigations revealed leucocytosis, thrombocytopenia, kidney and liver dysfunction, as well as elevated C-reactive protein levels. Serological tests confirmed the presence of both Leptospira IgM and Orientia tsutsugamushi (scrub typhus) IgM antibodies, indicating coinfection. Such dual infections are infrequently documented in this region, highlighting the diagnostic challenge. Management and Outcome: Based on clinical suspicion and laboratory confirmation, the patient was promptly started on doxycycline alongside broad-spectrum antibiotics like injectable third generation cephalosporin. This timely intervention led to significant clinical improvement, preventing the progression to severe complications that are commonly associated with delayed treatment in such cases. Conclusion: Coinfections involving leptospirosis and scrub typhus, although rare, should be considered in patients presenting with undifferentiated febrile illnesses, especially in endemic and agricultural regions. Early recognition and appropriate antibiotic therapy are essential to reduce morbidity and prevent mortality.

Background: Dengue is a vector borne viral illness affecting millions globally. According to the World Health Organization (WHO) estimates, 50 million dengue infections are recorded annually, and more than 2.5 billion people who are living in endemic areas are at risk of dengue infection. It has wide spectrum ranging from asymptomatic to severe form like Dengue hemorrhagic fever and dengue shock syndrome. It is characterized by thrombocytopenia, leucopenia, elevation of transaminases and electrolyte disturbances. Confirmation is by ELISA which may not be accessible in remote areas. Identification of hematological and biochemical findings can aid in the diagnosis in such situation. Objectives: to determine the hematological and biochemical abnormalities in Dengue patients. Materials and methods: This study was conducted at Shadan institute of medical sciences, a tertiary care centre. Around 50 cases of Dengue positive by ELISA method (NS1, IgM ) were evaluated for certain clinical and biochemical parameters. Age and Sex matched Controls were taken from patients who were suffering from other febrile illnesses without localising signs. Patients with Thrombocytopenia due to other causes were excluded. Blood samples were collected and hematological and biochemical parameters were analysed. Comparison of wbc count, platelet count (Hematology) serum electrolytes, transaminases, blood urea and serum creatinine(biochemical) between cases and controls was done. Ethical clearance was obtained from the institutional ethics committee. Results: Among the 50 Dengue patients, there were 33(66%) males and 17(34%) females. The age ranged from 12 years to 70 years. We have observed a significant rise in hematocrit of more than 20% in 2 cases (4 %).  Thrombocytopenia was seen in 96% of dengue patients., leucopenia was seen in 88% cases. Mean platelet count progressively fell from the day 3 and gradually increased from day 7 onwards. The Wbc count fell from day 3 and recovered from day 5 onwards. Neutrophil count progressively declined and the lymphocyte count gradually increased with the disease progression.  There was also an increased percentage of atypical lymphocytes in dengue patients (82%) . The platelet count and wbc count on admission was significantly lower in cases when compared with controls. ( p value <0.0001).  Biochemical findings included a significant rise in serum Transaminases (p value <0.001) in cases compared to controls.  There was a significant lower mean value of serum sodium levels (134.5 mmol/L) in cases compared to controls (139.6 mmol/L). Mean potassium levels were also comparatively lower in cases (3.8 mmol/L) compared to controls (4.27 mmol/L) . Mean urea levels were significantly higher in cases (32.35 mmol/L ) when compared to controls (25 mmol/l) (p value<0.05). Conclusion: Dengue being a viral illness with potential to cause serious consequences in it’s severe form, early diagnosis and management is beneficial to the patient. Due to absence of ELISA in remote areas, hematological and biochemical parameters can serve as a useful guide for diagnosis and management of the patient.

Background: Influenza A (H1N1) continues to cause significant morbidity and mortality worldwide, with variable clinical presentations and outcomes. Periodic evaluation of its clinical profile, associated comorbidities, radiological features, and outcomes is essential to improve case management and identify high-risk groups.Objective:To study the clinical profile, comorbidities, radiological findings, and outcomes of RT-PCR–confirmed H1N1 patients admitted to a tertiary care hospital. Methods This prospective cross-sectional analytical study was conducted in the Department of Internal Medicine, Max Super Specialty Hospital, Saket, New Delhi, from May 2019 to April 2020. A total of 207 adult patients with RT-PCR–confirmed H1N1 infection were included. Data regarding demographics, clinical features, comorbidities, laboratory investigations, chest radiographs, ICU admission, ventilatory support, and outcomes were recorded. Statistical analysis was performed using SPSS version 21.0, with chi-square applied; p < 0.05 was considered statistically significant. Results Males constituted 64% of cases, and the majority were in the 51–60 years age group (32%). Fever (88%) and dry cough (80%) were the most common symptoms. Breathlessness, myalgia, sore throat, coryza, and diarrhea showed significant associations with mortality (p < 0.001). Hypertension (37%) and diabetes mellitus (33%) were the leading comorbidities, with all comorbidities significantly associated with death. Laboratory abnormalities including anemia, leukocytosis, thrombocytopenia, and deranged liver and kidney function were significantly higher among non-survivors. Abnormal chest radiographs were present in 61% of patients and were significantly associated with mortality (p = 0.011). Overall mortality was 6%. Conclusion H1N1 infection most commonly affected middle-aged adults, with comorbidities, abnormal laboratory parameters, and radiological findings strongly predicting adverse outcomes. Early identification and close monitoring of high-risk patients are crucial to improve survival

Background: Decompensated chronic liver disease (DCLD) encompasses advanced stage of liver dysfunction, often associated with various hematological abnormalities consisting of anemia, thrombocytopenia, and coagulation disorders, which not only tells about disease severity but also states the risk of complications such as gastrointestinal (GI) bleeding. This study aimed. To assess the hematological abnormalities and type of anemia ,to assess the WBC , platelets , coagulation abnormalities To evaluate association between hematological abnormalities with severity of disease. Methods: This was The prospective cross sectional observational study was performed at the General Medicine department in a Tertiary Care Urban Teaching Hospital in Ahmedabad, Gujarat, India with inpatient cases of decompensated liver disease with study duration of one year Results: Most of the patients (39%) in the study were in middle age group 40-50 years    with mean age of  42.9 years. Among all, 52% patients had history of alcohol, and all were male. 12% patients positive for HBS Ag and only 4% shows positive for anti HCV antibody. Majority of 55% had altered consciousness, 95 % patients had anemia. In this study majority(47%) patients had CPS class B Leucopenia was present in 22% of patients. thrombocytopenia was found in 84 % patients. 87 % patients had prolonged prothrombin time. Majority 25% patients had high INR(>2.0) Conclusion: The most common anemia in cirrhotics is normochromic normocytic anemiaLeucopenia occurs in a small fraction of patients .Thrombocytopenia is present in most of the cirrhosis patients and is associated with increased bleeding tendencies.Increasedprothrombin time and APTT due to decreased synthesis of clotting factors.

Chronic alcohol consumption is associated with significant alterations in hematological parameters, including red blood cell (RBC) indices, white blood cell (WBC) counts, platelet levels, and biochemical markers, which may serve as early indicators of systemic effects and aid in the diagnosis and management of alcohol-related disorders. This systematic review, conducted following PRISMA guidelines, analyzed studies published between 2019 and 2025 that investigated hematological changes in individuals with chronic alcohol use. Databases including PubMed, Scopus, and Web of Science were searched for observational, cross-sectional, or cohort studies reporting on RBC indices, WBC counts, platelet levels, or biochemical markers in alcohol users. A total of 22 studies met the inclusion criteria, consistently demonstrating that chronic alcohol intake leads to macrocytic anemia, evidenced by elevated mean corpuscular volume (MCV) and reduced hemoglobin and RBC counts. Leukopenia and thrombocytopenia were also prevalent, indicating compromised immune function and increased bleeding risk. Furthermore, biochemical markers such as MCV, gamma-glutamyl transferase (GGT), and carbohydrate-deficient transferrin (CDT) were elevated, reflecting liver dysfunction and excessive alcohol intake, while alcohol withdrawal syndrome was associated with fluctuations in hematological and inflammatory markers. These findings highlight that chronic alcohol use profoundly impacts hematological and biochemical profiles, underscoring the importance of routine hematological screening in individuals with alcohol use disorders to enable early detection and timely intervention.

Background: Assessment of difficult airways may be challenging sometimes before surgical procedures. Conventional clinical tests like Mallampati score have low sensitivity and specificity in predicting difficult airways. USG has become indispensable in anaesthesia settings in localising vessels, nerve blocks and intra-articular assess. USG has gained significant attention in the recent past for assessment of difficult airways which was the aim of our study by measuring anterior neck soft tissue thickness on USG (DSE, DSVC) to predict difficult airways. Methods: We conducted our prospective observational study on ASAI/II elective surgery patients; 180 patients, 78 were males and 102 were females. BMI and Mallampati score. of all patients was measured and correlated with CL Grades. It was followed by measurement of DSE and DSVC which were correlated with CL scoring system. Sensitivity, specificity, PPV, NPV and P value were measured and correlated for significance. Results: We found moderate association between BMI and CL scoring system with 61.5% of patients with BMI of 30-35 having CL Grade 3& 4 and 78.6% of patients with BMI>35 having CL score of 3 & 4. Mallampati score was moderately sensitive in assessing difficult airways with sensitivity and specificity of 70% and 90% respectively. We used DSE of 1.7 as cut-off and found DSE cut-off of 1.7 having sensitivity and specificity of 89% and 85.8% respectively in detecting difficult airways with P value of <0.001. DSVC cut-off of 0.75 was found significant in our study group with sensitivity and specificity of 90.7% and 86.8% respectively with P value of <0.001. We found USG parameters as excellent predictors of difficult airways as compared to BMI and Mallampati score. Conclusion:  Conventional clinical tools are moderately sensitive in detecting difficult airways and USG assessment has shown better sensitivity and specificity in predicting difficult airways. DSE and DSVC measurement by USG has shown excellent predictability in detect difficult airways much better than conventional tools and have shown promising results in the management of difficult airways.

Background: Dengue causes characteristic hematological and biochemical abnormalities during acute infection. The presence of diabetes mellitus may modify these laboratory patterns through underlying metabolic and endothelial dysfunction. Objectives: To compare hematological and biochemical parameters between dengue patients with and without diabetes mellitus and assess whether diabetes is associated with distinct laboratory abnormalities during acute dengue infection. Methods: This cross-sectional analytical study was conducted in the Department of General Medicine at K. B. Bhabha Municipal General Hospital, Mumbai, over one year (June 2023–June 2024). A total of 100 confirmed dengue patients (25 diabetics and 75 non-diabetics) were included. Hematological indices (hemoglobin, hematocrit, leukocyte count, and platelet count) and biochemical parameters (liver function tests, renal markers, and electrolytes) were measured at presentation. Diabetes mellitus was defined by previous diagnosis or HbA1c ≥ 6.5%. Statistical comparisons were made using the t-test and Chi-square test, with p < 0.05 considered significant. Results: Both groups exhibited comparable hemoglobin levels, leukocyte counts, and overall platelet reduction. Severe thrombocytopenia was marginally more frequent among people with diabetes, though not statistically significant. Biochemical profiles showed more pronounced elevation of AST and ALT levels in diabetic patients (p < 0.05), along with a mild trend toward higher serum urea and creatinine and lower sodium levels. These differences indicate greater hepatic and metabolic stress in the diabetic subgroup. Conclusion: While hematological abnormalities were similar in dengue patients irrespective of diabetes status, biochemical derangements—particularly liver enzyme elevation—were more prominent among people with diabetes. This suggests that diabetes may potentiate hepatic vulnerability during dengue infection, warranting closer biochemical monitoring in this comorbid population

Background: Thrombocytopenia is a common haematological abnormality frequently encountered in clinical practice. However, it can often be overlooked if specific investigations are not conducted. Acute febrile illness (AFI) accompanied by thrombocytopenia presents a significant diagnostic and therapeutic challenge, as the severity of thrombocytopenia is inversely related to the mortality and morbidity associated with various febrile illnesses. Vector-borne and zoonotic diseases such as malaria, dengue, scrub typhus, and leptospirosis are prevalent causes of fever with thrombocytopenia. Additionally, infections and sepsis are notable contributors to this clinical presentation. Proper identification and management of these conditions are crucial in improving patient outcomes, especially in tertiary care settings where a diverse array of infectious agents can be encountered. The clinical and etiological profile of patients presenting with acute febrile illness and thrombocytopenia in a tertiary care hospital highlights the importance of thorough investigation and targeted treatment strategies. Objectives:

1. To evaluate the clinical and etiological profile of acute febrile illness with thrombocytopenia patients
2. To find out the prevalence of organ specific complications in acute febrile illness with thrombocytopenia cases
3. To determine the relationship between platelet, count and bleeding manifestation according to underlying cause.

Methods: This cross-sectional study was conducted at Hassan Institute of medical sciences Hassan.  , Karnataka. A total of 140 patients with acute febrile illness and thrombocytopenia, meeting inclusion criteria and willing to participate, were assessed. Socio-demographic data and clinical history were recorded using a semi-structured proforma. Past illnesses were confirmed by blood investigations. Data were meticulously entered into an Excel spreadsheet for statistical analysis using R version 4.2.2 statistical software. P value < 0.05 was considered as statically significant. Results: The study included 140 patients with acute febrile illness and thrombocytopenia, consisting of 63 females (45%) and 77 males (55%), with a mean age of 44.89±17.40 years. The most affected age group was >40≤60 years, comprising 43.57% of patients. Blood pressure anomalies were minimal, with only 5% (7 patients) hypertensive and 12% (17 patients) hypotensive (Figure 6). Tachycardia was observed in 30 patients. The mean lowest platelet count was 70,514±36,642.84 cells/mm³. Thrombocytopenia severity varied, with 86 patients (61.43%) classified as mild, 48 as moderate, and 6 as severe. Among the patients, 80 (57.14%) were diagnosed with dengue fever, followed by Rickettsia (22.14%), leptospirosis (10%), viral infection (7.1%), and unexplained cases (6.43%). All patients presented with fever; other common symptoms included headache (85%), body ache (84.29%), vomiting (75%), abdominal pain (50%), altered sensorium (10.71%), and bleeding manifestations (5.7%). Physical findings showed that 37.86% of patients had rashes, and 15% had breathlessness. Severe thrombocytopenia patients exhibited the highest incidence of rashes (66%) and bleeding manifestations (50%). Abdominal pain was most prevalent among dengue patients (56.25%). Comparisons between different thrombocytopenia grades revealed that severe grade patients had significantly higher mean blood urea and serum creatinine levels than mild and moderate grade patients (p-value = 0.041). Ultrasound imaging showed gallbladder stones in 22.14%, xvii ascites in 22.57%, and pleural effusion in 20.71% of patients. Gallbladder stones were more common in males (31.17%) than females (11.11%) (P-value = 0.05). Ascites was present in 42.86% of males, but not in females (p-value < 0.0001). Pleural effusion was observed in 32.47% of males and 6.35% of females (p-value = 0.0002). Severe thrombocytopenia was associated with higher incidences of gallbladder stones (66.67%), ascites (66.67%), and pleural effusion (50%) compared to moderate and mild cases (p-values = 0.00003, 0.0008, and 0.022, respectively). Patients with severe thrombocytopenia also had significantly higher mean total bilirubin levels and SGOT compared to those with mild and moderate thrombocytopenia. Conclusion: Acute Febrile Illnesses (AFI) have a variety of causes, and accurate diagnosis is critical. The degree of thrombocytopenia in infections has predictive significance. It can also aid in the differential diagnosis and accurate identification of the etiology of acute febrile diseases. Detecting and managing thrombocytopenia in acute febrile sickness on time can improve the patient's overall outcome

Background: Intramuscular injections are contraindicated in individuals with hemophilia because of the high risk of deep muscle hematoma formation and secondary infection, complications that may result in significant morbidity. While spontaneous and trauma-related muscle bleeds are well described, injection-related hematomas have become increasingly uncommon in modern clinical practice due to improved awareness. We report a rare and severe case of a post-injection gluteal hematoma with extension into the thigh and psoas muscle in a patient with severe Hemophilia A, complicated by infection, thrombocytopenia, and recurrent inflammation. Case Presentation: A 35-year-old man with severe Hemophilia A developed extensive intramuscular and subcutaneous hematomas following a tetanus toxoid injection. Despite early factor VIII replacement, the hematoma expanded and progressed to secondary infection. Serial ultrasonography and CT angiography revealed a massive multiloculated collection measuring up to 46.5 cm along the posterior thigh and gluteal region. Factor VIII therapy was optimized and antibiotic therapy escalated based on clinical and inflammatory markers. Image-guided drainage under factor coverage facilitated clinical improvement. Inhibitor screening remained consistently negative. Conclusion: This case illustrates the catastrophic potential of intramuscular injections in hemophilia and underscores the importance of preventive immunization strategies, early hemostatic correction, close imaging surveillance, and multidisciplinary management.

Background: Malignancy is a well recognized prothrombotic state that is frequently complicated by intravascular coagulation and fibrinolysis (ICF). Coagulation parameters such as prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, D-dimer and platelet counts have emerged as accessible prognostic tools in oncologic practice. Aim: To evaluate coagulation profile abnormalities in newly diagnosed solid malignancies and to assess the prevalence and pattern of ICF across different tumor types and clinical characteristics. Methods: This prospective observational study was conducted over 18 months at a tertiary care center in Surat, India, and included 150 indoor patients of all ages and both sexes with histopathologically or cytologically confirmed solid malignancies. Hematologic malignancies, known bleeding diathesis and hemorrhagic stroke were excluded. Coagulation profile included PT, APTT, fibrinogen, D-dimer, fibrin degradation products (FDP) and platelet counts. ICF categories were defined using D-dimer and platelet levels as no ICF, overcompensated, compensated and decompensated ICF. Associations with tumor site, histology, metastasis and lesion size were analyzed using ANOVA, chi-square test and correlation analysis, with p < 0.05 considered statistically significant. Results: The most frequent cancer sites were gastrointestinal (23.3%), head and neck (17.3%), female reproductive tract (13.3%), respiratory system (11.3%) and breast (10.7%). Prolonged PT and APTT were observed in 25.3% and 34.7% of patients respectively. Elevated D-dimer (>243 ng/mL) occurred in 60.0%, abnormal fibrinogen levels in 39.3% (low 14.0%, high 25.3%), FDP positivity in 32.7% and thrombocytopenia in 14.0%. Metastatic disease (18% of patients) was associated with significantly higher PT, APTT, D-dimer and fibrinogen levels, and higher FDP positivity (p < 0.01 for all). Lesion size correlated positively with fibrinogen (r = 0.265, p = 0.001). Based on ICF classification, 40.0% had no ICF, 7.3% overcompensated, 41.3% compensated and 11.3% decompensated ICF. Conclusion: Coagulation abnormalities are highly prevalent among patients with solid malignancies and are more pronounced in metastatic and aggressive histologic subtypes. D-dimer and fibrinogen levels, together with platelet counts, are useful markers of subclinical ICF and may assist in risk stratification for thrombo-hemorrhagic complications. Routine coagulation profile assessment at diagnosis can aid early recognition and supportive management in oncology practice.

Background: Pediatric septic shock is a serious condition with high risk of morbidity and mortality, especially in lower-resource settings. Recognizing factors associated with mortality is critical to improving management outcomes.  Objective: To identify demographic, clinical, and laboratory factors associated with mortality in children with septic shock admitted to a tertiary care hospital in Eastern India. Methods: Over one year, we conducted a prospective observational study in which we enrolled 125 children aged from one month to twelve years with septic shock. Clinical and laboratory parameters were collected including Glasgow Coma Scale (GCS), initiation of vasoactive medications, need for mechanical ventilation, acute kidney injury (AKI) and hematologic parameters. Statistical analysis was performed to assess the associations and independent predictors of mortality. Results: A total of 125 patients with clinically diagnosed septic shock were included with 64.8% of participants being under the age of five years. The overall rate of mortality was 34.4%. Pneumonia was found to be the most prevalent etiology (42.4% of cases). Independent, strong predictability of mortality included GCS less than or equal to 8 at admission, use of vasoactive medication, use of mechanical ventilation, AKI, and thrombocytopenia (p <0.05). While higher leukocyte counts were associated with worse outcomes, blood culture positivity was not statistically associated with outcome. Discussion: The findings affirm earlier research that recognized neurologic impairment, organ dysfunction, and cardiovascular instability as strong predictors of mortality in pediatric septic shock. The signs of pneumonia and organ dysfunction emphasize the importance of identifying and treating these cases early and with aggressive resuscitation in the emergency department.  Conclusion: Early identification of pediatric septic shock patients within high-risk categories using clinical assessment markers such as GCS, organ dysfunction, and need for hemodynamic support may help guide the implementation of intensive care interventions that may improve survival in resource-limited settings.

Background: Dyspnea in pregnancy and the postpartum period is a critical symptom that may indicate underlying life-threatening cardiac or respiratory disorders. This study aimed to evaluate the clinical and laboratory characteristics of pregnant and postpartum women admitted with acute onset dyspnea at a tertiary care center. Methods: A cross-sectional study was conducted on 112 women presenting with acute dyspnea (NYHA/MMRC grade II–IV) admitted to the Medicine ward and MICU. Detailed demographic, obstetric, clinical, biochemical, radiological, and echocardiographic data were collected, hospital course, final outcomes, fetal outcomes were noted. Results: The mean age of patients was 27.18±5.17 years. Most patients were young (20–30 years) with high rates of overweight/obesity and anemia. Hypertensive disorders with pulmonary edema and eclampsia were the leading causes, followed by ARDS and sepsis. ARDS (51.8%) and pulmonary edema/CHF (22.3%) accounted for nearly three-fourths of cases. Common abnormalities included tachypnea, tachycardia, hypoxemia, anemia, thrombocytopenia, hyperkalemia, and renal dysfunction. Maternal mortality was 33%, mainly due to ARDS and hypertensive pulmonary edema, with postpartum women showing higher fatality. Adverse neonatal outcomes such as preterm births and NICU admissions were frequent in critically ill mothers. Conclusions: Acute dyspnea in pregnancy is a sentinel event signaling high maternal and perinatal risk. Postpartum women are particularly vulnerable. Simple bedside and laboratory markers can aid early detection in resource-limited settings. Prompt triage, multidisciplinary management, and improved antenatal screening for hypertension, anemia, and infections are vital to reducing maternal mortality.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with multisystem involvement and variable clinical severity, where early recognition of organ involvement and immunological markers is crucial for prognosis. The present study aimed to evaluate the clinical and immunological profile of patients with systemic lupus erythematosus (SLE) at a tertiary care center in Central India. Methods: Eighty-one adult patients (≥18 years) with confirmed SLE based on the 2019 ACR–EULAR criteria were enrolled. Demographic, clinical, biochemical, and immunological data were collected, and disease activity was assessed using SLEDAI scores. Mortality predictors were analyzed using logistic regression and ROC analysis. Results: All patients were female, with a mean age of 29.4 years; 73.9% were aged 21–35 years. Common complaints included fatigue (93.8%), swelling (88.9%), breathlessness (86.4%), and joint pain (77.8%). Pallor (53.1%), pedal edema (42%), nail changes (48.1%), and alopecia (34.6%) were frequent findings. Severe anemia occurred in 50.6%, thrombocytopenia in 53.1%, and leukopenia in 21.3%. Renal involvement was significant, with 45.7% exhibiting nephrotic-range proteinuria. Hyponatremia (39.5%), low HDL (72.8%), and dysglycemia (44.4%) were common. ANA IFA showed nuclear (38.3%) and homogeneous (28.4%) patterns, with anti-dsDNA and RNP antibodies most frequent. High disease activity (SLEDAI 11–19) was observed in 59.3%. Mortality was 7.4%, associated with high SLEDAI, lupus nephritis (LN) Class 4 and 5, and basal crepitations. Logistic regression confirmed these as independent predictors, with LN Class 4 showing the highest predictive ability (AUC 0.81). Conclusion: Fatigue, swelling, breathlessness, and joint pain were predominant. Renal involvement and high SLEDAI strongly predicted mortality. ANA patterns and specific antibodies reflected active autoimmunity, while LN Class 4, high SLEDAI, and basal crepitations were key prognostic markers.