Background: Dengue fever is one of the most important emerging infectious diseases constituting important contribution in global burden of disease. Platelet transfusion is required in the patients when they develop Dengue Hemorrhagic Fever (DHF) or thrombocytopenia below 20,000/ cu.mm without hemorrhage. Serial platelet counts are used to monitor the patients. In this study we investigated whether Mean Platelet Volume (MPV) could be used as a tool to predict development of significant thrombocytopenia, DHF and Dengue Shock Syndrome (DSS). This may help in triage of high-risk patients and readiness of the care-givers for platelet transfusion when required. Methods: In this prospective study done in IIMSAR, Halides, 100 cases of dengue were included. In those patients who developed thrombocytopenia < 20,000/cu.mm, the MPVs prior to development of this significant thrombocytopenia, were compared with the mean of the MPVs of all the patients under the study. Statistical analysis was done using t-test. Results: On the previous day on which platelet count was < 20,000/cu.mm, mean MPV was significantly low (p value < 0.0001) compared to the mean of MPVs of all the patients. Conclusion: Serial MPV monitoring can be used to predict significant thrombocytopenia.

Background It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. Methods We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. Results Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I2 37%) were significantly lower for people with previous macrovascular disease. Conclusions This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.

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