1. Dr.Humra nasim PGT-Medicine HFH,RWP
Risk factor profile of dengue hemorrhagic fever in adult patients attending a tertiary care hospital in Rawalpindi, pakistan
Dr.Humra nasim
PGT-Medicine
HFH,RWP

2. INTRODUCTION
Dengue is a mosquito-borne infection found in tropical and sub-tropical regions of more than 100 countries. Two-fifths of the world’s population or 2500 million people are now at risk for dengue, and every year approximately 50 million new cases occur world wide. The global prevalence of dengue infection has increased dramatically in recent decades, particularly in the Americas, Western Pacific, and South-east Asia.

3. The identification of risk factors of DHF has its implications for clinical practice. It helps the physicians to prioritize care during an outbreak of dengue infection.
RATIONALE OF STUDY
This study will explore demographic and co morbidity risk dactor for DHF such as young age, male gender, secondary dengue infection, diabetes mellitus, hypertension and hyperlipedemia. Identifying risk factors for DHF can facilitate early clinical, preventive and healthcare resource management.

4. Operational definitions:
OJECTIVES OF STUDY
To determine the frequencies of risk factors of dengue hemorrhagic fever patients attending a tertiary care hospital in Rawalpindi,Pakistan.
Operational definitions:
Dengue hemorrhagic fever:
The criteria for diagnosis of DHF will be based on Malaysia’s Clinical Practice Guidelines for Dengue Infections in Adult 2010.Individuals are suspected to have DHF when they have acute febrile illness (fever >38 °C) of 2-9 days along with thrombocytopenia ,plasma leakage and hemorrhage. Plasma leakage can be detected by ascites, pleural effusion, pericardial effusion, pericholecystic fluid and thick gall bladder wall on ultrasonography and 20% rise in heamtocrit from baseline or 20% drop in hematocrit after fluid therapy.    .

5. In the absence of baseline HCT level, HCT value of >40% in females and >46% in male should raise the suspicion of plasma leakage. Hemorrhagic tendencies included a positive tourniquet test, skin bleeding( petechiae,ecchymosis or purpura) bleeding from mucosa (epistaxis, gum bleed or from other sites), hemetemesis and malena.

6. Risk factors for DHF: This will refer to the cause or set of causes of DHF like:
Age: Age will be determined by the history. Age will be labeled positive if more than 14 and ≤ 30 years.
Gender: Gender will be positive if male gender.
Secondary infection: Secondary infection is defined as positive IgG regardless of IgM result .
Diabetes mellitus: random blood sugar >200mg at 2 occasions.
Hypertension: blood pressure of either or both systolic BP of >140 mm Hg or diastolic BP of >90 mm Hg at 2 occasions.
Hyperlipidemia:When either or both total cholesterol is above 240mg/dl or LDL above 160mg/dl.

7. Methodology: Study design: Descriptive Cross sectional Study.
Study setting: This study will be conducted at Department of infectious diseases, Holy Family hospital, Rawalpindi.
Duration of Study: six months after approval of synopsis.
Inclusion criteria: Patients with DHF above 14 years and ≤30years of age, and of either sex will be included in the study.

8. Exclusion criteria: The exclusion criteria for this study was
(1) Simple dengue fever diagnosed on the basis of IgM with no criteria meeting DHF
(2) Known co morbids like renal failure (serum Cr> 3mg/dl), heart failure (EF < 30% on echocardiography) know malignancy (confirmed on biopsy report) ), cirrhosis of liver and hypoalbuminemia as these can be misleading in diagnosis of DHF, and can result in bias in the study.

9. Data collection:
This study will be conducted after the approval of Institutional Research Forum of RMC. The patients fulfilling the selection criteria will be selected by consecutive sampling method from the department of infectious diseases of Holy family hospital, Rawalpindi. Written consent will be taken by patients. For the diagnosis of different risk factors of DHF, a detailed relevant history will be obtained and a meticulous physical examination will be all performed for patients. After history and examination basic investigations will be performed for each patient including hematocrit [Hct], total leucocyte count, as well as serum IgM , IgG level serology. The information regarding patient’s presentation will be collected on pre-tested structured questionnaire by the trainee herself to collect data uniformly for all the patients.

10. Data analysis:
All the data will be entered and analyzed through Statistical Package of Social Sciences (SPSS v 22). For continous variable like age Mean and SD will be calculated.. Frequency and percentages will be calculated for categorical variables like gender, age group, presence or absence of risk factors i-e secondary dengue infection DM, HTN, hyperlipidemia. .