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Summary of clinical presentation in dengue fatal cases seen at UMMC between June 2006 to October 2007.
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Background
Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths.
Methodology/Principal Fi...
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p>Background Dengue hemorrhagic fever (DHF) remains a major health problem in tropical countries. The case fatality rate (CFR) can be reduced from 45% to <1%, if dengue shock syndrome (DSS) is treated early and adequately. Early biomarkers for DSS outcomes in children are needed. Interleukin-8 (IL-8) might be one of the molecule, as it plays a role...
Citations
... Although severe bleeding was not statistically significant in the L/B predictive model, we retained it in the final prognostic model based on disease pathogenesis and evidence from the previous medical literature. [5,22,27] The clinically developed model showed good discrimination performance, with C-statistics in the training and test sets of 0.954 and 0.946, respectively; however, this model had poor calibration with a skewed distributed curve in the calibration plot ( Fig. 2A). Therefore, prognostic models that combine clinical covariates and biomarkers Table 1 Clinical and laboratory characteristics of study participants in the first 24h of PICU admission and associated outcomes at discharge (N = 492). ...
This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807–0.944), and that of L/B ratio 0.867 (95% CI, 0.80–0.934) ( P values of both biomarkers < .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (>30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96–38.3; P < .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15–1.58; P < .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS.
... higher mortality rate for men than women 23 . Also, according to evidence from different studies, biological differences in gender affect the severity and outcomes of COVID-19, with men experiencing more severe and worse outcomes [24][25][26] . Our data also showed that the mean age men who died was significantly 2 years higher than the age of the deceased women, highlighting the role of age in the severity of COVID-19 outcomes in line with other studies 22,27 . ...
This study was designed and implemented to analyze and establish documents related to the above cases in the first to third COVID-19 epidemic waves for the use of researchers and doctors during and after the epidemic. The current case series study was conducted on 24,563 thousand hospitalized COVID-19 patients by examining their clinical characteristics within a one-year period from the beginning of the pandemic on 02.22.2020 to 02.14.2021, which included the first to the third waves, based on gender and severity of COVID-19. The mean age of the participants was 56 ± 20.71, and 51.8% were male. Out of a total of 24,563 thousand hospitalized COVID-19 patients until February 2021, there were 2185 mortalities (9.8%) and 2559 cases of severe COVID-19 (13.1%). The median length of hospitalization from the time of admission to discharge or death in the hospital (IQR: 13–41) was estimated to be 21 days. The rate of hospital mortality was higher in severe (37.8%) than in non-severe (4.8%) cases of COVID-19, While the risk of severe cases increased significantly in the third (HR = 1.65, 95% CI: 1.46–1.87, P < 0.001) and early fourth waves (HR = 2.145, 95% CI: 1.7–2.71, P < 0.001). Also, the risk of contracting severe COVID-19 increased significantly in patients aged ≥ 65 years old (HR = 2.1, 95% CI 1.1.93–2.72, P < 0.001). As shown by the results, the rates of hospital mortality (9.3% vs. 8.5%) and severe cases of COVID-19 (13.6% vs. 12.5%) were higher among men than women (P < 0.01). In our study, the mortality rate and severity of COVID-19 were within the scope of global studies. Men experienced higher severity and mortality than women. The was a significantly higher prevalence of old age and underlying diseases in individuals with severe COVID-19. Our data also showed that patients with a previous history of COVID-19 had a more severe experience of COVID-19, while most of these patients were also significantly older and had an underlying disease.
... 32 Sebuah penelitian di Malaysia yang mengkaji kematian akibat dengue menunjukkan 100% kasus tersebut merupakan infeksi dengue sekunder. 33 Penelitian lain di Pakistan menunjukkan 75% kasus kematian yang berhubungan dengan DSS merupakan infeksi dengue sekunder. 34 ...
Infeksi dengue sekunder merupakan infeksi dengue yang terjadi kali kedua. Infeksi kedua dengan serotipe berbeda dapat menyebabkanpenyakit dengue yang lebih berat. Penelitian menunjukkan bahwa 98% kasus dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) merupakan infeksi dengue sekunder. Patofisiologi yang menjadikan infeksi dengue sekunder lebih berat belum sepenuhnya dipahami, diduga berkaitan dengan mekanisme antibody dependent enhancement (ADE). Membedakan infeksi dengue primer dan sekunder penting agar dokter dan tenaga kesehatan mampu memprediksi prognosis dan keluaran klinis pasien. Dengue secondary infection is the second dengue infection. A second infection with different serotype tend to be more severe. Data shown that 98% cases of dengue hemorrhagic fever/ dengue shock syndrome (DHF/DSS) are dengue secondary infection. The pathophysiology of more severe cases is not fully understood; it is suspected to be related to antibody dependent enhancement (ADE) mechanism. Differentiating primary and secondary dengue infection is important to predict patient’s prognosis and clinical outcome
... School-based health education is a commendable tool to enhance knowledge, attitude, and practice and creates awareness among school children about the seriousness of MBDs since this disease is particularly prevalent among them (Sam et al., 2013;Midzi et al., 2014). School age children have been encouraged to participate in ongoing household MBDs control activities, such as source reduction, as part of MBDs control efforts (Khun & Manderson, 2007;Kebede et al., 2020). ...
Background: Mosquito-borne diseases (MBDs) are among the important and highly complex issues in public health. School age children have been encouraged to participate in ongoing household MBDs control activities such as source reduction, as part of MBDs control efforts. Numerous school-based health education studies have been conducted worldwide on the interventions to prevent MBDs. However, the results are still varied and uncertain. This systematic review aims to answer the question of:” Are school-based educational programs able to improve students’ knowledge, attitudes, and practices about mosquito-borne diseases?”. Methods: This systematic review was conducted using the Preferred Reporting Items for systematic reviews and meta-analyses (PRISMA) statement. A systematic literature search was performed using Sciencedirect, Cochrane library, PubMed, ProQuest, and the Wiley Online Library in the time period of 2000 to 2021. Eligibility criteria was determined according to PICOS guidelines. Quality and risk of bias of the studies were assessed by the effective public health practice project tool (EPHPP) and Cochrane risk-of-bias tool (RoB-2), respectively. Data were analyzed qualitatively, by looking at the number of participants, study design, and the main results obtained in each of the included studies. Results: In the initial search, 1,424 studies were found. Duplicates, those not relevant to students and MBDs, review articles, case reports, dissertations and non-English articles were eliminated. Twenty-three studies fulfilling the inclusion criteria were analyzed. Overall, there was an increase in knowledge, attitude, and practice regarding MBSs. However, knowledge appears to be the most important variable targeted by the included studies. All studies stated a significant increase in knowledge. Conclusion: The effect of the educational interventions on knowledge was more prominent. Future studies need more specialized educational interventions to have a stronger impact on students’ attitudes and performance. Further research is also needed to generate stronger evidence and evaluate the long-term impact of these interventions on students’ knowledge, attitudes, and practice. The results of this review can be a guide to carry out appropriate interventions in elementary schools.
... 6 . This observation might be due to females having a higher tendency to progress to having Dengue haemorrhagic fever (DHF)/ Dengue Shock Syndrome (DSS) with higher fatality numbers in comparison to males 13 . On the contrary, out of 15 mortality cases over 32 months seen in another retrospective study, 73% of them were males 14 . ...
... According to current and previous studies, in the presence of both dengue infection and underlying comorbidities as mentioned earlier, fatality rates were higher than in individuals with no underlying comorbidities. The reason for death in dengue cases with co-morbidities may be due to the progression of concomitant diseases itself, and not due to the dengue infection straightforwardly, especially in adults 13 . This data shows that patients who have comorbidities that are infected with dengue infection should be monitored closely and more particularly compared to patients who do not have comorbidities, as each patient should be managed differently according to their conditions. ...
Introduction: Malaysia has a high concentration of dengue cases. Even though the case fatality rate is low among dengue patients, identification of the risk factors of dengue mortality helps in the management of these patients. Findings from previous studies were inconclusive, thus, we systematically review studies to identify the factors of mortality among dengue patients in Malaysia. Methods: Three main search engines such as PubMed, ScienceDirect and EBSCO were used to screen the articles. This systematic review follows PRISMA guidelines. Results: The initial search yielded a total of 523 articles to be reviewed. However, after screening, four articles were left with all of them being quantitative studies. From the four studies accepted, thirty-six factors were identified. The factors include age, gender, nausea, vomiting, bleeding, lethargy, body ache, abdominal pain, retro-orbital pain, dysuria, shock, pleural effusion, ascites, prolonged Prothrombin Time (PT), Haematocrit (HCT)>20%, Serum pH <7.35, Serum ferritin >10,000 ni/mL, serum creatinine, serum lactate >2, white blood cell (WBC) count, insulin dependant diabetes, ischemic cardiovascular disease and progressive renal disease. Conclusions: To conclude, age and bleeding were found as the most important health risk for Dengue patients and poses a great liability towards mortality among patients infected with dengue in Malaysia.
... higher mortality rate for men than women (21). Also, according to evidence from different studies, biological differences in gender affect the severity and outcomes of COVID-19, with men experiencing more severe and worse outcomes (22)(23)(24). Our data also showed that the risk of severe cases of COVID-19 was higher in men than women, although there was no signi cant difference (Table 1). ...
This study was designed and implemented to analyze and establish documents related to the above cases in the first to third COVID-19 epidemic waves for the use of researchers and doctors during and after the epidemic. The current case series study was conducted on 24563 thousand hospitalized COVID-19 patients by examining their clinical characteristics within a one-year period from the beginning of the pandemic on 02.22.2020 to 02.14.2021, which included the first to the third waves, based on gender and severity of COVID-19. The mean age of the participants was 56 ± 20.71, and 51.8% were male. Out of a total of 24563 thousand hospitalized COVID-19 patients until February 2021, there were 2185 mortalities (9.8%) and 2559 cases of severe COVID-19 (13.1%). The median duration of hospitalization was 13 days for patients with severe cases of COVID-19 (IQR-7-23). The rate of hospital mortality was higher in severe (37.8%) than in non-severe (4.8%) cases of COVID-19, While the risk of severe cases increased significantly in the third and early fourth waves (HR=1.672, 95% CI: 1.48-1.89, P<0.001). Also, the risk of contracting severe COVID-19 increased significantly in patients aged ≥ 65 years old (HR=2.1, 95%CI: 1.1.93-2.72, P<0.001). As shown by the results, the rates of hospital mortality (9.3% vs. 8.5%) and severe cases of COVID-19 (13.6% vs. 12.5%) were higher among men than women (P<0.01). In our study, the mortality rate and severity of COVID-19 were within the scope of global studies. Men experienced higher severity and mortality than women. The was a significantly higher prevalence of old age and underlying diseases in individuals with severe COVID-19. Our data also showed that patients with a previous history of COVID-19 had a more severe experience of COVID-19, while most of these patients were also significantly older and had an underlying disease.
... This is consistent with other studies that had raised hematocrit levels in DHF/ DSS as compared to dengue fever. 28,29 Our analysis proved that high hematocrit is linked to SD, and its measurement has been the most common method used to identify hemoconcentration. ...
Early diagnosis of dengue is crucial to prevent the progression to severe dengue (SD) leading to mortality rate reduction. This study aimed to determine the role of the CXCL10 in dengue and its potential utilization as one of the biomarkers for the early diagnosis of dengue. A case-control study was conducted involving healthy subjects as control (n = 10) and 193 subjects as dengue cases. The cases were categorized into dengue without warning signs (DwoWS: n = 70; 34.5 %), dengue with warning signs (DWWS: n = 108; 23.2 %), and severe dengue (SD: n = 15; 7.4 %). The socio-demographic characteristics, clinical presentations, and laboratory parameters (platelet and hematocrit) were documented. Serum CXCL10 quantification was performed using an enzyme-linked immunosorbent assay (ELISA). The descriptive analysis and Pearson’s correlation test were used to analyze demographic data and the correlation between CXCL10, hematocrit, and platelet respectively. The difference in age (p = 0.02) and ethnicity (p = 0.02) were significant between cases and control. Males more frequently had SD in contrast to females (4:1). The frequent warning signs were abdominal pain (42.0 %), severe vomiting (38.3 %), bleeding tendency (15.0 %), and fluid accumulation (7.2 %). The increase in hematocrit (p = 0.039) and platelet reduction (p = 0.0005) were significant in SD. The mean of CXCL10 in control (134.85 ± 48.52 rg/mL) was significantly lower than in cases (545.22 ± 76.33 rg/mL, p = 0.0005). The CXCL10 is evident to be a potential biomarker in the early diagnosis of dengue.
... To help clinicians evaluate the likelihood of severe disease, risk factors for SD have been reported, such as secondary infection, gastrointestinal pain, vomiting, diarrhea, intravascular leakage and bleeding [12]. Efforts have been consistently made to identify predictive markers for SD [13][14][15]. ...
Background
Dengue is a major public health issue worldwide and severe dengue (SD) is life threatening. It is critical to triage patients with dengue infection in the early stage. However, there is limited knowledge on early indicators of SD. The objective of this study is to identify risk factors for the prognosis of SD and try to find out some potential predictive factors for SD from dengue fever (DF) in the early of infection.
Methods
The PubMed, Cochrane Library and Web of Science databases were searched for relevant studies from June 1999 to December 2020. The pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CI) of identified factors was calculated using a fixed or random effect model in the meta-analysis. Tests for heterogeneity, publication bias, subgroup analyses, meta-regression, and a sensitivity analysis were further performed.
Findings
A total of 6,848 candidate articles were retrieved, 87 studies with 35,184 DF and 8,173 SD cases met the eligibility criteria. A total of 64 factors were identified, including population and virus characteristics, clinical symptoms and signs, laboratory biomarkers, cytokines, and chemokines; of these factors, 34 were found to be significantly different between DF and SD, while the other 30 factors were not significantly different between the two groups after pooling the data from the relevant studies. Additionally, 9 factors were positive associated with SD within 7 days after illness when the timing subgroup analysis were performed.
Conclusions
Practical factors and biomarkers for the identification of SD were established, which will be helpful for a prompt diagnosis and early effective treatment for those at greatest risk. These outcomes also enhance our knowledge of the clinical manifestations and pathogenesis of SD.
... A previous multivariate analysis 8 has also reported prior dengue infection as one of the risk factors of DHF 8 . Two other studies 21,22 from Southeast Asia reported that secondary dengue infection were risk factors of dengue shock syndrome (DSS) encompassing grade 3 and grade 4 DHF, and even associated with deaths. ...
- Objective: The mortality of dengue hemorrhagic fever (DHF) infection in children is still high. Discriminating dengue fever (DF) and DHF during the early phase is difficult, especially with limited diagnostic tools in peripheral areas. Hence, early identification of significant factors in diagnosing DHF is important, with rapid disease progression may lead to mortality. This study aims to determine early clinical and laboratory parameters significant in differentiating DF and DHF.
— Materials and methods: This is a cross-sectional study using secondary data from medical records collected by purposive sampling from January 2015 to December 2020. This study included children aged 0-18 years old diagnosed with DF and DHF based on World Health Organization (WHO) 2011 criteria.
— Results: From multivariate analysis of 528 dengue patients, presence of prior dengue infection (OR = 7.1; 95% CI: 2.1-23.7, p=0.001), transfusion administration (OR = 34; 95% CI: 8.7-132, p<0.001), present hepatomegaly (OR = 7.2; 95% CI 1.3-38.2, p=0.02) and other bleeding manifestations (OR = 3.5; 95% CI 1.3-9.3, p=0.012) are significant parameters to differentiate DF and DHF with good quality of discrimination (AUC value = 0.83) and the model is a good fit (Hosmer-Lemeshow value = 0.65). ROC analysis showed two significant variables yielded 55.6% of sensitivity and 86.3% of specificity.
— Conclusions: Two or more characteristics of present hepatomegaly, other bleeding manifestations, transfusion received, and prior dengue infection are specific to dengue infections yet less sensitive to differentiate DF and DHF
... A proporção de gênero entre os óbitos foi equilibrada (51,4% sexo masculino), mas, considerando a proporção entre os casos (45,7% sexo masculino), a mortalidade foi ligeiramente maior entre homens, o que difere da descrição de outros autores, onde as mulheres apresentam maior risco de óbito (13) . ...
... Divergindo de outros estudos, onde crianças e jovens apresen taram maior gravidade (13,14) , as maiores taxas de letalida de ocor re ram entre idosos, demonstrando maior vulnerabilidade deste grupo, associada à presença de comorbidades (destacando-se hi-pertensão arterial sistêmica (HAS) e cardiopatias, reforçando a importância do manejo clínico de dengue, também nessas condições. ...
... Os tempos médios para internação e óbito foram concordantes com o descrito na literatura (13,14) , reforçando a necessidade de maior atenção na transição da fase febril para a fase crítica (entre 4 a 7 dias da doença). Complicações hepáticas e neurológicas costumam ser um pouco mais tardias (2)(3)(4) , com o pico de alteração das aminotransferases no 9º dia de doença (15) . ...
RESUMO OBJETIVO: A dengue tem importância mundial por sua mor-bidade e abrangência. O presente artigo teve como objetivo descrever as principais características dos óbitos por dengue, ocorridos no Município do Rio de Janeiro (MRJ), durante a epidemia de 2012. MÉTODOS: Foram descritos os 35 casos de óbitos por dengue ocorridos em 2012 neste município. As variáveis estudadas foram coletadas a partir das fichas de inves-tigação de óbitos por dengue, padronizadas pelo Ministério da Saúde. RESULTADOS: Encontrou-se maior proporção de óbi-tos entre 50 e 59 e acima de 70 anos, presença de comorbidades em 77,8%, ligeiro predomínio do sexo masculino e da raça/cor preta. Principais achados hematológicos: leucopenia em 46,8%, leucocitose em 78,1%, hemoconcentração em 39,4% e plaque-topenia em 87,9%. Na parte bioquímica: aumento de amilase em 50%, gama GT em 92,8%, transaminase glutâmico oxa-loacética (TGO) em 95,2%, transaminase glutâmico pirúvica (TGP) em 80,9%, bilirrubinas em 69,2%, creatina-fosfoquinase (CPK) em 50% e lactato desidrogenase (LDH) em 100%. Der-rame cavitário foi descrito em 64,3% e espessamento de parede da vesícula biliar em 37,5%. Manifestações atípicas evidencia-das: neurológicas 8,6%, insuficiência hepática 11,4%, insufi-ciência renal 25,7% e sangramento 22,8%. CONCLUSÃO: O acompanhamento de exames laboratoriais e de imagem auxilia o manejo clínico e a predição da gravidade da dengue. Este acom-panhamento, juntamente com a estabilização das morbidades preexistentes, pode reduzir sua letalidade. ABSTRACT OBJECTIVES: Dengue has global significance for its morbidity and scope. This article aims to describe the main features of deaths due to dengue, during the dengue epidemic in Rio de Janeiro (MRJ) in 2012. METHODS: The 35 cases of obit by dengue occurred in 2012 in this municipality were described. The studied variables were collected from the records of investigation of obit by dengue, standardized by the Ministry of Health. RESULTS: Review of 35 deaths due to dengue that occurred in the city of Rio de Janeiro in 2012 showed a higher proportion between ages of 50 and 59 and also greater than 70 years old, the presence of comorbidities in 77.8% and a slight prevalence in male gender and in race/color black. Major hematologic findings were leukopenia (46.8%), leukocytosis (78.1%), hemoconcentration (39.4%) and thrombocytopenia (87.9%). Other lab abnormalities were amylase (50%), gamma GT (92.8%), aspartate aminotransferase (AST) (95.2%), serum glutamate pyruvate transaminase (SGPT) alanine transferase (ALT) in 80.9%, bilirubin in 69.2%, creatine phosphokinase in 50% (5/10) and lactate dehydrogenase in 100%. Cavity effusions were described in 60% and thickened gallbladder in 37.5%. Atypical symptoms that were evident: neurological 8.6%, liver failure, 11.4%, kidney failure, 25.7% and bleeding 22.8%. CONCLUSION: Monitoring the levels of hematocrit, platelets, aminotransferases and imaging tests help the clinical management and prediction of severity of dengue and, along with the stabilization of preexisting comorbidities, may reduce its lethality. A dengue configura-se importante problema de saúde públi-ca, por seu potencial de endemicidade e grande impacto social por sua morbidade.
