The global prevalence of dengue cases has increased in India. The increasingly widespread distribution and the rising incidence of dengue virus infections are related to increased distribution of Aedes aegypti, an increasingly urban population, and increasing air travel. Several countries show that the age of the reported dengue cases has increased from 5-12 years, to older children and young adults. Although shock and plasma leakage seem to be more prevalent as age decreases, the frequency of internal hemorrhage rises as age increases. Increase in liver enzymes found in both children and adults indicated liver involvement during dengue infections. Pre-existing liver diseases in adults such as chronic hepatitis, alcoholic cirrhosis, and hemoglobinopathies may aggravate the liver impairment in dengue infection. Fulminant hepatitis is a rare but well described problem in adult patients with dengue infection. Currently, no specific therapeutic agent exists for dengue. The early recognition of dengue infection, bleeding tendency, and signs of circulatory collapse would reduce mortality rates in adult patients with dengue infection.

Introduction: Pain is subjective in nature. It can express different manners by the patient (or) Individuals. The role of diagnostic pain procedures is considered very important. It can be classified into acute pain (i.e ; short lived pain)and chronic pain (i.e; pain that lasts for months). It shows effect on socio economic status of the patients. Poor pain management is likely to persist until pain management practices became consistent with guidelines developed from the best available scientific evidence. In case of rational pain management needs pain assessment. So pain assessment plays a major role in rationalize pain management. Method : We conducted a single centered observational analysis of adults age 45years undergone Total knee replacement surgery from August2018-January2019 at GBR Super speciality hospital, palnadu road, Narasaraopet. Pain assessment was assessed by facial pain scale. Results: A long proportion of 48 patients had undergone TKR. Pain assessment is done by using facial pain assessment scale. Male patients have mild pain (3 points) at the time of discharge. Female patients have moderate pain (4 points) after the surgery. Conclusion: Pain assessment plays a major role in the management of chronic and acute pain. Articular damage belongs to unsteadiness of the involved knee was a source of pain and by controlling unsteadiness subjecting the articular damage soreness were decreased greatly .So, early assessment of the pain will be more beneficial to the patient.