THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[18-08-2025 11:53] PPM 3: 21/M
1. COMPLAINTS AND DURATION
C/o fever since 7 days
Vomiting since 3 days
Cough since 2 days
2. HISTORY OF PRESENT ILLNESS
Patient was apparently normal 7 days back then he developed fever; insidious in onset, high grade, associated with chills & rigors.
H/o diurnal variation (↑ at night). Vomiting – 8–9 episodes/day, non-bilious, non-blood stained, containing food particles.
Cough – non-productive, h/o diurnal variation (↑ at night).
No h/o hemoptysis. No h/o hemetemesis
3. HISTORY OF PAST ILLNESS
No h/o DM, HTN, CVA, CAD, TB, Epilepsy, Thyroid illness
[18-08-2025 11:57] PPM 3: After test dose of injection monocef was given, he developed a swelling right forearm, and a swelling at left arm (after pricking for sample)
On 14/8/25 he developed petechiae over the chest
On 15/8/25
SDP transfusion was done.
[18-08-2025 10:09] PPM 1: @PPM3 please share more about this patient.
Begin with an image of his fever chart, serial hemogram and platelets and history
[18-08-2025 10:10] PPM 3: Ok sir, sharing in sometime.
[18-08-2025 11:31] PPM 1: Appears to have recovered from his dengue
[18-08-2025 11:32] PPM 3: Yes sir, but he developed another complication meanwhile
Sharing Everything in detail soon
[18-08-2025 11:50] PPM 1: Today is 18th. The chart shows till 15?
[18-08-2025 11:51] PPM 3: He stopped having fever spikes, only 1 episode at presentation
[18-08-2025 11:57] PPM 3: Has reached to this stage
[18-08-2025 12:08] PPM 1: Fever charting needs to show that the fever is absent, and hence charting needs to continue.
The chart also serves as an important patient timeline for other data such as daily platelet count
Check out PPM4's work here when he was a PG: https://durgakrishna09.blogspot.com/2023/08/graphical-patient-timeline-in-soap.html?m=1
[18-08-2025 12:14] PPM 3: Alright sir, I'll complete it
[18-08-2025 12:14] PPM 3: I wrote the platelets here though
[18-08-2025 12:15] PPM 1: Could be classified as minor bleeding and didn't warrant sdp transfusion!
Here's an elegant study from Malaysia which should have put a stop to this practice but clearly the evidence doesn't percolate although we journal clubbed it: https://pubmed.ncbi.nlm.nih.gov/28283286/
[18-08-2025 12:16] PPM 3: This was not the bleeding
[18-08-2025 12:16] PPM 3: He had petechiae on the chest
[18-08-2025 12:16] PPM 1: Helps to see everything at a single glance in one fever chart timeline
[18-08-2025 12:17] PPM 3: Ok sir,will update now👍🏻
[18-08-2025 12:17] PPM 1: All skin bleeds are same.
[18-08-2025 12:23] PPM 3: He didn't have the ecchymosis then
[18-08-2025 12:37] PPM 1: Petechiae is the same skin bleed pinpoint and less than 5 mm and echymosis is more than that
[18-08-2025 12:40] PPM 3: I meant on 14 he just had a swelling not a ecchymosis
[18-08-2025 12:40] PPM 3: He did have petechiae though
[18-08-2025 12:40] PPM 3: On chest
[18-08-2025 12:40] PPM 3: But I understand now
[18-08-2025 12:40] PPM 3: Anything doesn't warrant for sdp transfusion
[18-08-2025 12:41] PPM 3: No unfortunately didn't take that picture
[18-08-2025 12:41] PPM 1: Major or moderate bleed would warrant
[18-08-2025 12:41] PPM 3: By anything I meant the ecchymosis or petechiae
[18-08-2025 12:46] PPM 1: Recruited patients aged at least 21 years who had laboratory-confirmed dengue (confirmed or probable) and thrombocytopenia (≤20 000 platelets per μL), without persistent mild bleeding or any severe bleeding
The primary endpoint was clinical bleeding (excluding petechiae)
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