Interleukin 11 and Stem Cell Factor Levels in Patients with Disseminated Intravascular Coagulation: A Report of Four Cases

Interleukin 11 (IL-11) and stem cell factor (SCF) stimulate platelet production. In this study, we examined serum IL-11 and SCF levels in 4 patients with disseminated intravascular coagulation (DIC) complicating massive trauma and infections. The serum concentrations of both IL-11 and SCF showed a marked increase coinciding with the development of DIC in these patients, regardless of the presence or absence of infections. Further studies are required to confirm whether the increase in levels of these two platelet- inducing cytokines with the onset of DIC reflects an enhancement of platelet production in order to maintain the biological system in balance, or simply an inflammatory biological response.


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Significantly Raised Brain Natriuretic Peptide in a Young Patient with Dengue Fever without Heart and Renal Failure

Objective: This is the fi rst case report of association of raised brain natriuretic peptide (BNP) in patients with dengue fever (DF). BNP is raised in patients with heart failure. It can also be elevated in renal failure and subarachnoid haemorrhage in the absence of heart failure. Raised BNP has never been described in patients with DF. Clinical features: We describe a young patient with DF who complained of sudden onset breathlessness on day 3 of admission. She was found to have right sided crepitations. Myocardial screen was done which was negative but BNP was 3555 pg/ml. Her SpO2 and arterial blood gas while breathing room air was normal. There was no elevated jugular venous pressure, pedal edema or laboratory evidence of heart failure. There was no renal impairment or systemic infl ammatory response syndrome. A transthoracic 2-dimensional echocardiography was normal. Treatment: Patient was treated with intravenous fl uids and oral clarithromycin for 5 days. Outcome: Patient was discharged on day 8 of admission. She was well but follow-up BNP was high but on downward trend. She refused any further invasive investigations for heart. Conclusions: BNP may be raised in patient with DF without heart failure. The exact pathogenesis of raised BNP in DF is unclear.


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Unilateral Diaphragmatic Pacing: An Innovative Solution for Unilateral Diaphragmatic Paralysis

Mechanical ventilation has always been a cornerstone of respiratory support for patients with respiratory muscle paralysis. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with signifi cant advantages in life quality. We report an interesting case of unilateral diaphragmatic paralysis in which unilateral diaphragmatic pacing produced signifi cant improvement in quality of life.


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