Dengue hepatic severity score: A glimmer to the clinician

Introduction: Recent studies from India and Thailand show that dengue infection was the most compelling cause of acute hepatic failure in children contributing to 18.5% and 34.3%, respectively, and till now, there is no proper dengue severity score based on the hepatic dysfunction, i.e. laboratory as well as clinical hepatic parameters. Objective: The objective of this study was to develop a new dengue hepatic severity score (DHSS) based on only hepatic dysfunction parameters. Methods: The present cross-sectional analytical study was conducted in the Department of Paediatrics, Burla, Sambalpur, Odisha, from November 2015 to October 2017 after getting the institutional ethical clearance. A total of 76 cases selected as per predefined inclusion and exclusion criteria, categorized into three groups after taking written informed consent of their legal hare. Relevant hepatic parameters (both clinical and laboratory) were collected, and data were finally analyzed using receiver operating characteristic curve to get a cutoff value for each group. Results: The cutoff value of DHSS of ≥7 between Group 1 and Group 2 evidenced by area under the curve (AUC)=99.6% with 95% confidence interval (CI) (95.6–100%), sensitivity - 100%, specificity - 94.6%, and a cutoff ≥18 between Groups 2 and 3 exhibited by AUC=100% with 95% CI (94.6–100%), sensitivity - 100%, and specificity - 94.6%. Hence, the DHSS is formulated as ≤6 (no severe hepatic dysfunction), 7–17 (severe), and ≥18 (very severe). Mean duration of hospitalization in days between three groups of hepatic dysfunction was statistically significant as evidenced by one-way ANOVA; F (2, 73)=19.83, p=0.000. Conclusion: DHSS system will help the primary health caregiver for triaging, early recognition, and prompt management to prevent additional deterioration

Pulse oximetry as a screening tool for congenital heart disease in neonates: A diagnostic study

Introduction: Many studies have been done for screening of congenital heart disease (CHD) in the neonatal period utilizing pulse oximetry as a screening tool along with routine clinical assessment, but none of them from our province. Objective: The objective of the study was to find out the diagnostic accuracy of pulse oximeter at three different sites as a screening tool to diagnose CHD among neonates. Methods: A diagnostic study was conducted in neonatal intensive care unit of a tertiary care hospital of Odisha from October 2016 to September 2018 after approval from the Institutional Ethics Committee. Three hundred and seventy-four neonates (both inborn and outborn) with gestational age >34 weeks were included in the study. Oxygen saturation (SpO2) in the right hand (RH), right foot (RF), and left foot (LF) was estimated by pulse oximeter among all participants after 10 min of postnatal life. All the study subjects were evaluated by two-dimensional (2D) echocardiography for the detection of CHDs. All the diagnostic accuracy tests (sensitivity [Sn], specificity [Sp], positive predictive value, negative predictive value, and diagnostic odds ratio) were calculated taking 2D echocardiography as the gold standard with software, and for all statistical purpose, p<0.05 was considered statistically significant. Results: Cutoff value of the RH SpO2 was 90.0% with Sn of 68.80% and Sp of 98.20%; area under curve (AUC) 0.851 (0.766 and 0.914), p<0.001, for the RF, SpO2 was 90.0% with Sn 78.0% and Sp 92.1%; AUC 0.865 (0.782 and 0.925), p<0.001, and for LF, it was 87% with Sn 77.1% and Sp 94.0%; AUC 0.864 (0.781 and 0.924), p<0.001. Conclusion: Along with the clinical skills, pulse oximetry can be used as an early screening tool for the detection of CHD in the neonatal period and of three different sites, RF found to be better