Background:The swine flu (H1N1) with rapid spread and panic in population is truly global pandemic, affected mainly younger population. There is need to accumulate evidence regarding patient's intensive care parameters for effective management of newer strains of influenza viral infections. Hence an observed retrospective record analysis of confirmed H1N1 patients admitted to intensive care unit (ICU) of a tertiary care centre is done.Aims:The study was designed to study the profile and pattern of H1N1 patients admitted to ICU and to study the distribution and associated factors with treatment outcomes.Materials and Methods:The demographic, clinical, and laboratory data of 32 (RT-PCR confirmed) H1N1cases were collected and analyzed using Fischer's exact test/paired t test between survivors and nonsurvivors to know their significance. This data included criteria for admission to ICU, type of lung injury, mode of oxygenation, antiviral, and other drugs used.Results:There were 11 males and 21 female. Age ranged from 19 to 72 years. Age group of 15–45 years had most cases (78%) and mortality (60%). Most common symptoms were fever and breathlessness (100%). The mean duration of breathlessness was statistically significant (P = 0.037) between two groups. Most common signs were tachycardia and tachypnea. The 75% cases developed acute respiratory distress syndrome (ARDS), of this 16% survived. Among these fatal cases nine were positive for procalcitonin (PCT) (P = 0.006). The rest of 25% developed acute lung injury (ALI) and recovered completely (P = 0.0001).Conclusion:Fever and breathlessness were the main presenting complaints. Tachypnea and tachycardia as clinical signs predict development of respiratory complications. Arterial blood gas analysis (ABG) and PaO2/FiO2 were important in deciding severity of lung injury and mode of ventilation. ARDS was observed to be the main cause of mortality in this study. Serum PCT level estimation is useful in determining outcome.

Lymphoma of the salivary gland accounts for 5% of cases of extranodal lymphoma and 10% of malignant salivary gland tumors. Most primary salivary gland lymphomas are B marginal zone lymphomas arising on a background of sialadenitis associated with an autoimmune disorder such as Sjorgen's syndrome. This report describes a case of primary B-cell lymphoma arising in the parotid gland in a middle-aged female, which was not associated with an autoimmune disorder. Immunohistochemistry studies confirmed the clonal B-cell nature of the tumor. This case highlights the fact that B-cell lymphoma in the salivary gland can go unrecognized due to its non-specific symptoms and requires immunohistochemistry studies for confirmation. We present this case for its rarity.

A 43-year-old male living in Bengaluru sought emergency services due to high-grade fever, headache, myalgia, abdominal pain and distension. Platelet count (except the first-96,000/mm3) and coagulation profile was in normal limits. The dengue serology was positive for IgM and Ig G (immunoglobulin M and G) antibodies. Ultrasound abdomen showed gross ascites, mild bilateral pleural effusion and hepatosplenomegaly. The patient continued to have abdominal pain and progressive distention Ascitic tap was hemorrhagic. Later laparoscopy showed 1.5 liters peritoneal fluid with blood clots and mild diffuse congestion of the peritoneum. Liver, spleen and blood vessels were normal. Then what would be the possible mechanism to explain hemoperitoneum, is it the increased vascular permeability caused by the virus? India being endemic for dengue illness, it is an interesting and rare case presentation.

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