I now have all the references I need. Let me compile the full PICOT and abstract.

Here is your complete PICOT framework and abstract, formatted exactly as required by the Hypothesis 101: Research Question Competition at Chirayu Medical College and Hospital.

P (Population): Adult patients (aged 18 years and above) admitted to the medicine ward of a tertiary care hospital with documented high-grade fever (axillary temperature ≥ 39°C or ≥ 102.2°F) at presentation or during hospital stay, irrespective of the underlying aetiology.

I (Intervention / Exposure): Presence of high-grade fever (temperature ≥ 39°C / ≥ 102.2°F), recorded at admission and monitored during the course of hospitalization. The severity and duration of fever will be documented, along with serial platelet counts at admission, 48 hours, and at discharge or day 7, whichever is earlier.

C (Comparison / Control): Adult patients admitted to the medicine ward with low-grade or no fever (axillary temperature < 38°C / < 100.4°F) as the comparison group, matched for age and sex, with platelet counts recorded over the same time intervals.

O (Outcome): Development of thrombocytopenia, defined as a platelet count below 1,50,000/mm³, in febrile patients compared to the non-febrile or low-grade fever group. Secondary outcomes include the degree of thrombocytopenia (mild: 1,00,000-1,50,000/mm³; moderate: 50,000-1,00,000/mm³; severe: < 50,000/mm³), need for platelet transfusion, bleeding manifestations, and length of hospital stay.

T (Time Frame): Over a period of 6 months.

Research Question: Is high-grade fever independently associated with thrombocytopenia in hospitalized adult patients?

Population: Adult patients (≥ 18 years) admitted to the General Medicine ward of a tertiary care hospital presenting with high-grade fever (axillary temperature ≥ 39°C) are the study population. Patients with pre-existing haematological disorders, those on anticoagulants or immunosuppressants, and pregnant women will be excluded to minimize confounding.

Intervention: The exposure of interest is high-grade fever (≥ 39°C / 102.2°F), documented at admission and monitored serially. Fever grade, duration, and pattern will be recorded. Complete blood count including platelet count will be obtained at admission, at 48 hours, and at day 7 or discharge. Relevant investigations to determine the aetiology of fever - including dengue serology (NS1 antigen, IgM/IgG), malaria peripheral smear and RDT, blood culture, scrub typhus serology, and Widal test - will be performed as clinically indicated.

Control: Adult patients admitted during the same period with low-grade fever (< 38°C) or afebrile status will serve as the comparison group. These patients will undergo identical platelet count monitoring and haematological assessment over the same time intervals.

Outcome: The primary outcome is the incidence of thrombocytopenia (platelet count < 1,50,000/mm³) in the high-grade fever group compared to controls. Secondary outcomes include the degree of platelet fall, correlation between peak temperature recorded and nadir platelet count, bleeding events, need for platelet transfusion, and in-hospital mortality. Fever is known to activate inflammatory cascades that promote platelet consumption and sequestration; diseases such as dengue, malaria, scrub typhus, leptospirosis, and sepsis are well-recognized causes of fever-associated thrombocytopenia, making early haematological surveillance clinically relevant.

Time Frame: The study will be conducted over a period of 6 months.

Good luck with the competition!

Your refined research question is clear and well-scoped. Here is the complete PICOT and abstract built around it exactly as the competition format requires.

P (Population): Adult patients aged 18 years and above admitted to the General Medicine ward of a tertiary care hospital presenting with fever of any grade (axillary temperature ≥ 37.2°C / ≥ 99°F). Patients with a pre-existing diagnosis of any haematological disorder (ITP, aplastic anaemia, leukaemia), those currently on anticoagulants, cytotoxic, or immunosuppressive therapy, and pregnant women will be excluded to prevent confounding of platelet counts.

I (Intervention / Exposure): High-grade fever, defined as an axillary temperature of ≥ 39°C (≥ 102.2°F), recorded at the time of admission and monitored every 8 hours during the hospital stay. Peak temperature over the first 48 hours will be used as the defining exposure. A complete blood count including platelet count will be performed at admission, at 48 hours, and at day 7 or discharge, whichever is earlier. The aetiology of fever will be investigated using dengue serology (NS1 antigen, IgM/IgG antibody), malaria peripheral smear and rapid diagnostic test, blood culture and sensitivity, scrub typhus IgM ELISA, Widal test, and urine routine examination as clinically indicated.

C (Comparison / Control): Adult febrile patients admitted during the same period with low-grade fever, defined as an axillary temperature between 37.2°C and < 39°C, serving as the comparison group. These patients will be matched for age and sex and will undergo identical serial platelet count monitoring and haematological workup over the same time intervals and under the same clinical setting.

O (Outcome): The primary outcome is the incidence of thrombocytopenia, defined as a platelet count below 1,50,000/mm³, in the high-grade fever group compared to the low-grade fever group. Secondary outcomes include the degree of thrombocytopenia stratified as mild (1,00,000-1,49,999/mm³), moderate (50,000-99,999/mm³), and severe (< 50,000/mm³); the correlation between peak recorded temperature and nadir platelet count; the need for platelet transfusion; bleeding manifestations; and in-hospital mortality.

T (Time Frame): Over a period of 6 months.

Research Question: Is the incidence of thrombocytopenia higher in patients with high-grade fever (≥39°C) compared to low-grade fever (<39°C) in a tertiary care hospital?

Population: Adult patients (≥ 18 years) admitted to the General Medicine ward of a tertiary care hospital presenting with fever will be enrolled. Patients will be divided into two groups based on their peak recorded axillary temperature: Group A (high-grade fever, ≥39°C) and Group B (low-grade fever, 37.2°C to < 39°C). Patients with known haematological malignancies, chronic liver disease, chronic immune thrombocytopenia, ongoing cytotoxic or anticoagulant therapy, and pregnant women will be excluded. A minimum sample size will be calculated based on expected prevalence from existing literature.

Intervention: The exposure under investigation is high-grade fever (≥39°C). Peak axillary temperature during the first 48 hours of admission will be the defining exposure variable. All enrolled patients will undergo complete blood count with platelet count at three time points: on admission (day 0), at 48 hours (day 2), and at day 7 or the day of discharge, whichever comes first. Fever aetiology will be determined through standardized investigations including dengue NS1 antigen and serology, malaria peripheral smear, blood cultures, scrub typhus IgM ELISA, and Widal test. Fever grade, duration, and pattern will be systematically recorded. High-grade fever promotes platelet destruction through multiple mechanisms - direct thermal suppression of megakaryopoiesis, cytokine-mediated platelet consumption (via TNF-α, IL-6, and IL-1β), immune complex deposition on platelet surfaces, and splenic sequestration - all of which are more pronounced at higher temperatures.

Control: Patients with low-grade fever (37.2°C to < 39°C) admitted during the same study period will form the control group, matched for age and sex. Identical haematological monitoring and aetiological workup will be performed in this group to ensure comparability.

Outcome: The primary outcome is the incidence of thrombocytopenia (platelet count < 1,50,000/mm³) in Group A compared to Group B. Prior studies confirm that acute febrile illnesses - particularly dengue, malaria, scrub typhus, leptospirosis, and sepsis - are strongly associated with thrombocytopenia, and the severity of platelet fall has been shown to correlate with disease severity and mortality. This study aims to establish whether fever grade alone, independent of aetiology, is a predictor of thrombocytopenia, which would have direct implications for early monitoring and clinical decision-making in febrile inpatients.

Time Frame: The study will be conducted over a period of 6 months.

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