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Background: Dengue is known to cause multi-organ dysfunction including cardiac involvement, In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis not reported as a common complication we present a case series of dengue fever with cardiac involvement observed during a period of month August to December 2021 at PBM & Associated Group of Hospital, Bikaner Rajasthan. Case presentation: We have been reported 9 cases of dengue complicated with cardiac involvement admitted to Wards and ICU at PBM & Associated Group of Hospital. Age group ranging from 15 to 65 years. In our case series out of 9 cases comparising 2 females and 7 males. The group had 5 cases of Dengue hemorrhagic fever with dengue shock syndrome, 2 cases had Dengue hemorrhagic fever, 2 cases had dengue shock syndrome. There is co-infection of dengue with malaria in 2 cases. All cases had acute dengue hepatitis. Blood transfusion and other empirical therapeutic methods used apart from meticulous fluid management to suit issue of each patient. Bed side USG, digital chest x-ray PA view & 2D ECHO scanning help in early detection of critical phase of dengue. Out of 9 cases with complicated dengue 7 patients recovered and 2 patients expired. Data were collected during hospital admission, stay and follow up visits. Methods: A prospective observational study was conducted on patients with age group more than 15 years and having confirmed dengue fever. Patient on medication affecting heart Rate, Rhythms, pre-existing heart disease and electrolytes abnormalities excluded. A base line ECG, Troponin I NT Pro BNP were done for all patients. The biomarkers were measured using Enzyme linked immune fluorescent assay and recommended cut off were used. Patients with increased biomarkers gone for 2D ECHO (As per criteria of European society of cardiology 2019). Conclusion: Myocarditis and cardiac involvement in dengue may be overlooked due to Nonspecific clinical finding and co-existing multi organ dysfunction. Atypical presentation of this case series may be due to micro-geographical variation and unusual out break of dengue. Co-infection of malaria should be considered in managing patients especially in endemic area. [ABSTRACT FROM AUTHOR]

The clinical spectrum of dengue fever is ever increasing as we encounter more cases of this disease regularly for the past few years. Dengue fever continues to surprise us with its myriad presentations and combinations with other disease entities. Catastrophic antiphospholipid antibody syndrome (APS) is uncommon and often a fatal form of primary APS. Here, we present a 37-year-old lady who presented with catastrophic APS with dengue fever. The coexistence of these two conditions has not been reported earlier, to the best of our knowledge.

ObjectivesNeonatal hemophagocytic lymphohistiocytosis (HLH) is a rare entity. The objective of the study was to describe the prevalence, clinical characteristics, interventions and outcomes of neonates diagnosed with HLH in the United States.MethodsA retrospective analysis of 2009, 2012, and 2016 Kids' Inpatient Database was performed. Neonates discharged/died with a diagnosis of HLH were identified and analyzed.ResultsAmong 11,130,055 discharges, 76 neonates had a diagnosis of HLH. Fifty-two percent (95% CI: 38.6–63.6) were males and 54% (95% CI: 39.7–68.5) were white. Herpes simplex infection was present in 16% (95% CI: 9.2–28.1). 24.4% (95% CI: 14.5–37.9) received chemotherapy, 11.5% (95% CI: 5.2–23.6) IVIG and 3.6% (95% CI: 0.8–14.4) allogenic hemopoietic stem cell transplantation. Organ dysfunction was commonly seen and severe sepsis was documented in 26.6% (95% CI: 16.4–39.9). Median LOS was 16 (IQR 7–54) days. The mortality was 42% (95% CI: 30.8–55).ConclusionsHLH is a rare diagnosis and carries a high mortality in neonates. Herpes simplex virus is the most common infection associated with neonatal HLH. HLH should be considered in the differential diagnosis in neonates presenting with multi-organ dysfunction or sepsis.

A three-year-old Saint Bernard was presented with history of chronic gastro intestinal disorder, with progressively elevating creatinine values and without any response to treatment. Molecular detection by polymerase chain reaction aided in diagnosis of the condition as chronic canine babesiosis with Multi Organ Dysfunction (MODS). Animal responded to treatment for Babesia gibsoni infection with Clindamycin and Doxycycline parenterally in the initial stages but succumbed to the infection later. The present paper describes a case of B. gibsoni infection leading to Chronic Kidney Disease (CKD) and its sequelae. [ABSTRACT FROM AUTHOR]

Objective: Allergic reactions from wasp stings usually occur shortly after the stings. Serious and less common systemic mani- festations including multiple organ dysfunction can also occur at a later time. Methods: Medical records of pediatric patients admitted because of wasp stings into the Faculty of Medicine Siriraj Hospital from 2000 to 2009 were reviewed. Results: Nine cases were admitted because of systemic reactions from wasp stings. Most required only intravenous fluid and antihistamine. Two young children developed multiple organ dysfunction more than 24 hours after multiple stings. Both patients required artificial ventilation. The first patient received 20 days of renal replacement therapy and recovered completely. The second patient developed sepsis during peritoneal dialysis and died on the 34th day. Conclusion: Clinicians should be aware that young children with multiple stings are at risk of multiple organ dysfunction. We suggest hospitalization for at least 48 hours to provide early detection of complications and management.

The clinical spectrum of dengue fever is ever increasing as we encounter more cases of this disease regularly for the past few years. Dengue fever continues to surprise us with its myriad presentations and combinations with other disease entities. Catastrophic antiphospholipid antibody syndrome (APS) is uncommon and often a fatal form of primary APS. Here, we present a 37-year-old lady who presented with catastrophic APS with dengue fever. The coexistence of these two conditions has not been reported earlier, to the best of our knowledge. [ABSTRACT FROM AUTHOR]

To characterize the mitochondrial respiratory chain complex IV(complex IV) activity and protein expression during polymicrobial sepsis. Polymicrobial peritonitis, a clinically relevant mouse model of sepsis, was generated by cecum ligation and puncture (CLP) in Sprague- Dawley rats. The rats were randomly divided into 3 groups as follows: the sepsis without resuscitation (S), sepsis and fluid resuscitated (R) group, and a control (C) group. Twelve hours after the sepsis model was established, tissue specimens were obtained from the myocardium, liver and skeletal muscle. Mitochondrial respiratory chain complex IV activity of all tissue specimens was detected by spectrophotometry. Western blot was used to measure the liver mitochondrial respiratory chain complex IV protein content. The ultrastructure changes of mitochondria were detected by transmission electron microscopy. In myocardial cells, complex IV activity decreased significantly in the S and R groups as compared to the C group. There were no differences in complex IV activity between groups in skeletal muscle cells while in liver cells, complex IV activity and content was significantly decreased for the S group but no differences were observed between the C and R groups. Increased matrix volume and reduced density with generalized disruption of the normal cristae pattern was most extensive in the liver, followed by cardiac muscle cells with that in skeletal muscle cells been relatively mild in the S group. Mitochondrial fusion/fission and mitochondrial autophagy was also observed in the S group by transmission electron microscopy. Mitochondrial ultrastructure was preserved in the R-group and was similar to that seen in the C-group. Changes in complex IV activity and mitochondrial ultrastructure, a manifestation of the mitochondrial dysfunction varied depending on cell type. These changes are partly reversed by fluid therapy. Therapies aimed at mitochondrial resuscitation should be explored. • Changes in complex IV activity and mitochondrial ultrastructure and occurs in sepsis. • These changes are partly reversed by fluid therapy. • Mitochondrial dysfunction occurs in early period of sepsis and plays an important role in MODS development. • Metabolic resuscitation leading to mitochondrial recovery may be necessary to improve survival. [ABSTRACT FROM AUTHOR]

Key Clinical Message We report a case of several autoimmune disorders eventually presenting as severe multi organ dysfunction syndrome caused by adult hemophagocytic lymphohistiocytosis ( HLH). Clinical and laboratory tests might lead to fatal misinterpretation without awareness of its diagnostic evaluation, as HLH shares common features with sepsis and immune-mediated systemic inflammatory response syndromes. [ABSTRACT FROM AUTHOR]

Acute-on-chronic liver failure is a clinical entity with high risk of mortality. These patients can have severe liver dysfunction complicated with multiple organ failure. Liver transplantation is the definitive treatment for these patients. Literature regarding management of acute liver failure with special emphasis on liver transplantation was reviewed. Lessons learnt from the management of patients with acute liver failure which could be extrapolated to the management of patients with acute-on-chronic liver failure are discussed. Significant improvement in outcomes of acute liver failure has been reported across the world. Several aspects in transplantation for acute liver failure were found to be relevant to the management of acute-on-chronic liver failure. These include defining criteria to identify patients needing early liver transplantation, prioritizing patients with acute liver failure on the waiting list, defining when to abandon transplantation in acute liver failure, emphasis on graft quality and the need for a multi-disciplinary approach to manage multiple organ dysfunction. Useful lessons can be learnt from the progress made in the management of acute liver failure and these can be extrapolated to the management of patients with acute-on-chronic liver failure. [ABSTRACT FROM AUTHOR]