A smaller number of confirmed dengue cases worldwide present with neurological symptoms such as headache, seizure, neck stiffness, drowsiness, altered sensorium, behavioural disorders, delirium, cranial nerves palsies, and rarely, spinal cord involvement. This report is about a 54-year-old female patient with dengue, who presented with acute spinal cord compression due to spontaneous spinal Subarachnoid Haemorrhage (SAH). She complained of sudden onset of febrile illness associated with headache, myalgia, retro-orbital pain, and low backache for three days, followed by sudden onset paraplegia three days after the onset of the illness. A haemogram was obtained, which showed a platelet count of 60,000/µL. She had antibodies against dengue NS1 and dengue Immunoglobulin M (IgM), but not against dengue IgG. A Magnetic Resonance Imaging (MRI) spine contrast imaging revealed a spinal SAH from the level of T12 to L1, as well as significant cord compression. An MRI of the brain revealed a SAH in the bilateral parieto-occipital region. She underwent an emergency laminectomy and complete haematoma evacuation. Postsurgical period was uneventful with complete recovery of sensation and weakness. In patients from endemic areas of dengue infection who present with fever and spinal cord involvement a high degree of suspicion of this disease should arise and it should always be investigated further for dengue-related neurological complications.

Laryngeal edema is a common complication of endotracheal intubation. It may range from mild and asymptomatic to respiratory distress and severe stridor leading to subsequent reintubation. It is crucial to assess the patency of the airway before extubation to identify patients with a risk of developing laryngeal edema. To prevent post-extubation laryngeal edema (PLE), intravenous corticosteroids or nebulized corticosteroids appear to be reasonably effective, reducing the need for reintubation by more than half. We present a case of a 59-year-old male who presented with an intracranial bleed and aspiration pneumonia. The patient developed PLE and was reintubated due to respiratory distress and treated with intravenous and nebulized corticosteroids. The patient was extubated two days later after adequate cuff leak test (CLT) results. If PLE causes respiratory distress, reintubation is the only definitive treatment and should not be delayed.

BackgroundManagement of a febrile patient is based on understanding the pathophysiology of an abnormal temperature and temperature regulation, impacts of fever, and its treatment. In the current study, we aimed to characterize and compare the epidemiological, etiologic, microbiological, serological, clinical, and outcome traits of febrile patients with acute neutropenia admitted to a tertiary care center in Western Maharashtra. MethodsAdult patients with a history of fever of less than two weeks' duration and without any immunosuppressive state were screened with predefined inclusion and exclusion criteria. General and demographic information (age and gender), and clinical examinations (type and duration of fever) were recorded. Biochemical, hematologic (total and differential cell counts), and immunologic measurements (rapid malaria, dengue, Leptospira, and viral hepatitis antigen antibodies) were performed. Data were analyzed using an appropriate statistical package. ResultsA total of 403 (214 males) young adults (aged: 29±11 years) with clinical presentation of fever were studied. The majority (n=361, 89.6%) had low-grade continuous fever with an average duration of 3±1 (mean±standard deviation (SD)) days. Headache and myalgia were the common symptoms present, and patients had an average hospital stay of 4±1 days. Dengue (55%) was the most common cause of febrile neutropenia, and all patients recovered well without antibiotics and granulocyte colony-stimulating factor. The mean C-reactive protein (CRP) level was 61.4±4.4 mg/L. CRP and procalcitonin (PCT) were directly correlated with the degree of neutropenia and inversely correlated with total leucocyte count (TLC). ConclusionsIt was highlighted from this study that antibiotics are not necessary for viral infections that have been diagnosed to stop the development of secondary bacterial infections. A clinician should be aware of "when not to use antibiotics," or the world will soon have to deal with superbugs.

Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.

Introduction: Coronavirus disease 19 (COVID-19) is a pandemic caused by a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2. Diabetes and its complications are major causes of morbidity and mortality. Patients with uncontrolled diabetes may be associated with poorer outcomes as compared with patients with good glycemic control. Methodology: A total of 120 patients with type 2 diabetes mellitus with COVID-19 were taken from a tertiary care center in Pune, Maharashtra, and included in the study following their voluntary informed consent. Results: It was observed that patients with poor glycemic control had a greater prevalence of symptoms including fever (64.9% vs 55.4%), cough (51.3% vs 42.2%), and dyspnoea (40.5% vs 27.7%). C-reactive protein (9.40 vs 5.66), D-dimer (668.2 vs 457.9), and ferritin levels (352 vs 238) were observed to be greater in patients with poor glycemic control. Chest X-Ray changes (45.9% vs 17.2%) and CT severity score (9.32 vs 5.79) were significantly greater in patients with poor glycemic control. Patients with poor glycemic control also had an increased incidence of O2 requirement, increased mortality, and a longer duration of hospital stay. Poor glycemic control was also associated with an increased incidence of complications like acute respiratory distress syndrome (35.1% vs 18.0%), sepsis with or without septic shock (18.9% vs 9.6%), acute coronary syndrome (13.5% vs 8.4%), acute kidney injury (18.9% vs 3.6%), acute hepatic injury (13.5% vs 2.4%), and other complications like diabetic ketoacidosis, pulmonary thromboembolism, and cerebrovascular accident (10.8% vs 6.0%). Conclusion: On the basis of our findings, we concluded that patients with poor glycemic control were associated with poorer outcomes and increased complications.