Objectives:To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients.Methods:Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study.Results:About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF (38.15 vs 18.6%). Hyperbilirubinemia was noted in 40 (18.2%) patients, 28 (12.7%) in DF and 12(5.5%) in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger (<20 years) age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72(32.7% vs 40(18.2%)]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/l in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years.Conclusion:Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic.List of abbreviations:DF: Dengue FeverDHF: Dengue Hemorrhagic FeverDSS: Dengue Shock SyndromeDIC: Disseminated intravascular coagulationALT: Alanine transaminaseAST: Aspartate aminotransferase

Background and Objective:Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia’s ancient hospital setting with an aim to recognize complications at earliest and improve case management in future.Methods:A retrospective observational study of 95 adult dengue deaths was performed at Mayo Hospital Lahore from July 1st 2011 to 31st December 2011 during a major dengue epidemic. Patients who tested positive by dengue IgM in the presence of acute fever fulfilling the World Health Organization criteria for Dengue Fever, Dengue Hemorrhagic Fever or Dengue Shock Syndrome and died within same setting, were included. Data regarding demographic profile, clinical and laboratory parameters along with treatment details were obtained and analysed. All records examined were anonymized.Results:Median age was 36 years (range13-80 years) among 95 deaths due to Dengue. Male gender comprised 60 (63.1%). Co-morbidities existed in 74 (77.9%) with hypertension in 21 (22.1%) diabetes in 11 (11.58%), liver disease in 9 (9.47%) and ischemic heart disease in 8(8.4%) cases. Patients presented at second day of fever for admission (range 1-8 days) and death occurred at a median of 4 days (range 30 minutes to 23 days). Hospital stay was for less than a week for seventy nine (83.2%) patients and 16 (16.8%) were admitted for more than 7 days. Critical care was required in 67(71%). Severe hepatitis occurred in 41 (43.1%), acute renal impairment occurred in 32 (33.7%) and disseminated intravascular coagulation in 16 (16.8%). Deaths were due to prolonged shock 49 (51.5%) fluid overload 46 (48.4%) and massive bleeding 18(19%) leading to organ failure.Conclusion:Decompensated shock complicated by either massive plasma leakage, frank bleeding, multi organ failure or deranged clotting profile results in enhanced mortality in Dengue infection. Co-morbidities especially Diabetes are poor prognostic factors in predicting Dengue mortality.

Objectives: In this study we aimed at establishing the safety of a very early discharge within 24 to 36 hours after a primary PCI. Study Design: Prospective Comparative study. Setting: Punjab Institute of Cardiology, Lahore. Period: July to December 2019. Material & Methods: We randomly assigned a ≤ 36 hours discharge protocol to the very low risk patients after a primary PCI. FASTEST score was used to identify the low risk group. Comparison was made at 30 days between early discharge and ordinary discharge low risk groups for outcomes like reinfarction, stent thrombosis (ST), target lesion revascularization (TLR), bleeding, stroke and death. Results: Among 329 very low risk primary PCI patients, 161 were randomly assigned to early discharge group and 168 to ordinary discharge group. The outcomes were similar at 01 month in early vs ordinary discharge groups. There was no significant difference in the rate of reinfarction (1.24% vs 1.79%, P value 0.68), ST (1.24% vs 1.19%, P values 0.96), TLR (1.24% vs 1.19%, P value 0.96) and bleeding (0.62% vs 0.59%, P value 0.97). There was no mortality or stroke. Conclusions: Using any of the scoring systems, very low risk patients should be routinely identified after primary PCI. Short term major adverse outcomes remain at a low and a very early discharge protocol can be safely implemented in this subgroup. In addition to saving health costs, this can be of particular value during outbreaks like COVID-19