c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 4 (

Dengue infection has become a serious public health concern. Dengue management protocols and the management of common complications arebeing updated often based on understanding the Pathophysiology of dengue infection. This understanding has definitely improved dengue management resulting in reduction in dengue deaths. At times, uncommon complications may be overlooked in busy and crowded clinical settings. Spontaneous localized retroperitoneal bleeding including bleeding into psoas muscle or Wunderlich Syndrome has been reported in few instances associated with dengue fever in this country and abroad. Thislife-threatening possibility must be born in mind when a clinician notices sudden deterioration of a dengue patient withoutsignificant thrombocytopenia, generalized bleeding manifestation or other evidence of extra vascular fluid loss. The management of this entity requires urgent restoration of the circulatory volume including urgent blood transfusion though, in general, clinicians are moreconcerned about fluid overload in the management of dengue patients. As awareness of this entity seems poor, further research and reporting of similar cases in medical literature will shed more light on this obscure entity and increase the awareness among clinicians with favorable results.

Purpose: To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India. Methods: This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed. Results: Of the 384 patients, 378 (98.67%) were confirmed to have orbital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures. Conclusion: There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings.