Dengue Patients Research Articles

Impact of secondary infections on dengue presentation: A cross-sectional study in a tertiary care hospital in Uttar Pradesh, India

BackgroundRecently, a wide range variety of manifestations, including a self‑limiting to severe illness, has been increasingly reported in dengue. Few studies attract attention to severe dengue, mainly observed in secondary infection. With this background, this study aims to provide a comprehensive overview to differentiate primary from secondary dengue using serology (IgG) and the possible association of severity of illness in secondary dengue. MethodsPresent retrospective cross-sectional study was conducted at a North Indian tertiary care center from September 2021 to January 2022. Clinical data of confirmed dengue patients from the medicine department were collected and assigned as primary and secondary dengue. ResultsOf the 220 dengue patients, 22 (10 %) had secondary dengue infection. Hemorrhagic manifestations were reported in 58/220 (26.4 %) cases while 7/22 (31.8 %) in secondary dengue. Prevalent hemorrhagic manifestations in secondary dengue include purpura (27.3 %), vaginal bleeding (4.5 %), melaena (9.1 %), and epistaxis (4.5 %). In addition, 42 (19.1 %) patients had pancytopenia, and 8 (36.6 %) cases were of secondary dengue. Hepatic dysfunction was noted in 164 (74.5 %) cases. Notably, all secondary dengue cases (22;100 %) had hepatic dysfunction and severe in 9 (40.9 %) cases. In addition, in secondary dengue patients, evidence of plasma leakages such as hypoproteinemia 7 (31.8 %) and ascites (35 %) were statistically more frequent. Overall, two deaths (0.9 %) were reported, and were one in each group. ConclusionsMany parameters, including hemorrhagic manifestation (melaena), hematological characteristic (pancytopenia), evidence of plasma leakage (hypoproteinemia and ascites), gastrointestinal (GB wall thickening and hepatic dysfunction) and reduction in mean hemoglobin and platelet count were found to be statistically significant in secondary dengue infection. Additionally, early classification of secondary dengue may help to anticipate its severity and allow for early strategic intervention/management to lower morbidity and mortality.

Clinicopathological profile & outcome of critically ill patients suffering from Dengue: Single Centre Experience during COVID Pandemic

Introduction: Dengue is endemic in our country contributing significantly in morbidity & mortality. This study was conducted to observe the clinic-pathological profile, presentation & outcome of critically ill dengue patients who required Intensive Care Unit admission. Methods: This observational study was conducted in ICU of a tertiary care hospital in Dhaka city from July 2021 to September 2021. Laboratory confirmed cases of Dengue patients admitted in ICU were included in the study. Results: Total patients were 40 with equal male-female distribution. Mean age of the patients was 39.17 ± 13.83 years with most of them (70%) in age group of 18-40 years. Direct admission through Emergency Room (42.5%) was more than transfer-in from indoor of same hospital & other hospitals (35% & 22.5% respectively). There were multiple reasons for ICU admission including hypotension (commonest reason), breathlessness, diarrhoea, abdominal distension, altered level of consciousness etc. Only 13 (32.5%) patients had co-morbidities like DM, HTN etc, and mean age of them was significantly higher than patients without co-morbidities (50.3 ± 13.31, vs 32.23 ± 6.88). Biochemical parameters showed that TWBC count was normal in most patients (n=27, 67.5%), thrombocytopenia was present in 35 (87.5%) patients during admission, hypocalcaemia was present in most patients (90%), liver enzymes were raised in most patients (87.5% & 95% respectively for AST & ALT) and three patients had AKI. Twenty percent patients needed vasopressor support for shock & 5% needed mechanical ventilator support for respiratory failure. Clinical condition was improved in 38 patients & most of them (82.5%) were transferred out from ICU within 6 days. Only two among forty patients expired despite resuscitative efforts. There was no significant difference in the biochemical parameters between survivors & non-survivors. Conclusion: As dengue specific treatment is not yet available, early recognition of the critically ill patients and immediate supportive treatment along with close monitoring in Intensive Care Unit is life-saving for the patients. Bangladesh Crit Care J September 2023; 11 (2): 68-74

Linear epitope mapping in the E and NS1 proteins of dengue and Zika viruses: Prospection of peptides for vaccines and diagnostics.

The arrival of the Zika virus (ZIKV) in dengue virus (DENV)-endemic areas has posed challenges for both differential diagnosis and vaccine development. Peptides have shown promise in addressing these issues. The aim of this study was to identify the linear epitope profile recognized by serum samples from dengue and Zika patients in the E and NS1 proteins of DENV and ZIKV. This cross-sectional study included individuals of all ages with laboratory-confirmed DENV and ZIKV infections, who were selected through convenience sampling. The serum samples from dengue and Zika patients detected epitopes evenly distributed across the viral proteins in a peptide microarray platform. However, several epitopes were located within "epitope hotspots", characterized by clusters of peptides recognized in more than 30% of the sub-arrays analyzed using individual or pooled serum samples. The serum samples from dengue and Zika patients showed a high level of cross-reactivity with peptides in the DENV and ZIKV proteins. Analysis using an additional peptide microarray platform, which contained peptides selected based on the results of the initial screening, revealed that two DENV and one ZIKV peptide, highly specific to their related viruses, were located within the epitope hotspots; however, they presented low detection rates (32.5, 35.0, and 28.6%, respectively). In addition, two DENV peptides detected at similarly high rates by both dengue and Zika patients were also found within the epitope hotspots. These hotspots contain several immunodominant epitopes that are recognized by a larger number of individuals when compared to 15-amino acid (aa) sequence peptides. Thus, epitope hotspots may have greater potential to serve as antigens in diagnostic tests and vaccine development than peptides composed of only 15 amino acids.

Impact of apoptotic biomarkers for prognosis of dengue disease severity among eastern Indian patients.

Dengue virus (DENV) induced severe manifestations is a precursor for fatality among infected patients. Previous autopsy examinations of severe dengue (SD) patients reported presence of apoptotic cells in liver, brain, intestinal and lung tissues. Thus, serum-level of major apoptotic proteins of dengue patients was evaluated in the current study, along with their biochemical parameters. Patients were categorized according to World Health Organization (WHO)-defined classification. DENV-infection was screened among 165 symptomatic patients by quantitative reverse transcription polymerase chain reaction, antidengue IgM, and IgG ELISA. Serum levels of apoptotic (Capase-3,7,8, Bcl-2 and FasL) and hepatic-markers, lipid profile, hematological parameters of 78 dengue-positive patients were determined by sandwich-ELISA/immunoturbidimetry/auto-analyzer. Significantly higher levels of caspase-3,7,8 and FasL was detected among SD patients compared to those without warning (WOW) signs. Amongst biochemical parameters, bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase serum concentrations significantly increased among severe patients. Principal component analysis followed by hierarchical clustering differentiated severe and with warning dengue patient groups from those WOW using caspase-3,7,8 and FasL biomarkers-thus clearly distinguishing severe-dengue group. Correlation analyses also established strong positive correlation between caspase-3,7,8 and FasL. Thus, serum level of caspase-3,7,8 and FasL during early stage of infection could be used as biomarkers for WHO-defined dengue disease severity.

Demographic and clinical features associated with dengue fever during an outbreak in North India

Background: Dengue is a viral mosquito borne disease that poses high medical burden in many regions of the world. Early diagnosis and prompt treatment are critical in reducing the overall morbidity and mortality associated with dengue fever. So, this study was conducted to study the overview of dengue fever and its clinical manifestations during an outbreak in patients in a tertiary care hospital. Methods: It was a cross sectional study which was conducted at a tertiary care hospital GMC Jammu. Nonprobability convenience sampling technique was used to enroll the study participants. Results: The 222 dengue patients were included in this study with mean age of the patients 33.2±11.32 SD years. Among the dengue patients, 74 (33.3%) tested positive for antigen Ns1Ag. IgM antibodies was positive in 20 (9.0%), IgG antibodies was positive in 10 (4.5%) and 18 (8.1%) of the patients tested positive for both IgG and IgM antibodies. Overall prevalence of antibodies that are specific to dengue was 22%. Conclusions: Dengue specific antigen was present in most of the patients. The major clinical and laboratory outcomes were fever, myalgia, headache/joint pain/body aches, diarrhea and vomiting. An overall prevalence of 22% of dengue specific antibodies was found in the patients.

An Experience from Public Sector tertiary care Hospital:Secondary data analysis of Dengue patients from 2013-2022

Background: This study aims to identify patient number trends in three tertiary care hospitals affiliated with Rawalpindi Medical University by conducting a secondary data analysis of past hospital records. Methods: A retrospective study, spanning from 2013 to 2022, was undertaken in three tertiary care hospitals (Holy Family Hospital, District Head Quarters Hospital, and Benazir Bhutto Hospital) affiliated with Rawalpindi Medical University. The analysis included data on outpatient department (OPD) visits, admission rates, confirmed cases, morbidity and mortality variables related to Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), fatalities, expiries %, and the predominant Dengue virus genotype. Statistical analysis utilized SPSS version 25.0. Results: The records encompassed 299,101 OPD patients in the three allied hospitals. Over the past decade, an epidemic occurred in 2019, witnessing a surge—87,680 OPD cases, 14,879 admissions, and 11,942 confirmed cases. A second peak in the current year saw 32,940 cases. Maximum fatalities occurred in 2021 (0.68%), followed by 2013 (0.57%). Dominant Dengue serotype was DEN-2, except in 2022, which showed both DEN-1 (40%) and DEN-2 (60%). Conclusion: Trend analysis of dengue cases from 2013 to 2022 revealed a peak in 2019, followed by the current year (2022), indicating a significant increase. The rise during the current epidemic, coupled with a new serotype (DEN-1), may be linked to human migration due to recent floods, population displacement, and virus evolution, evident in increased cases with different serotypes.

Evaluation of remote radiologist-interpreted point-of-care ultrasound for suspected dengue patients in a primary health care facility in Colombia

BackgroundEarly identification of plasma leakage may guide treatment decisions in dengue patients. This study evaluated the value of point-of-care ultrasound (POCUS) to detect plasma leakage and predict hospitalization or referral to a higher level of care in suspected dengue patients under routine conditions at a primary care facility in Colombia.MethodsWe conducted a cohort study between April 2019 and March 2020 in a primary care hospital in Cali, Colombia. We prospectively included and followed 178 patients who were at least 2 years old with fever of less than 10 days and clinician-suspected dengue. A trained general practitioner performed a standardized POCUS protocol. Images were quality-rated and overread by an expert radiologist, and her results and those of the general practitioner were compared using the Kappa index. Logistic regression was used to identify factors associated with plasma leakage at enrollment and explore its prognostic value regarding hospital admission or referral to a higher level of care.ResultsHalf (49.6%) POCUS images were of suitable quality to be interpreted. The proportion of plasma leakage reported by the radiologist was 85.1% (95% CI: 78.6–90.2%) and 47.2% by the study physician (Kappa = 0.25, 95% CI: 0.15–0.35). The most frequent ultrasound findings were ascites (hepatorenal 87.2%, splenorenal 64%, or pelvic 21.8%) and gallbladder wall thickening (10.5%). Plasma leakage was higher in subjects with thrombocytopenia (aOR = 4, 95% CI: 1.3–12.1) and lower in patients 30–59 years old (aOR = 0.1, 95% CI: 0.0–0.4) than in those 18 years old or younger. POCUS evidence of plasma leakage (aOR = 8.2, 95% CI: 2.2–29.9), thrombocytopenia (aOR = 6.3, 95% CI: 2.4–16.0) and pulse pressure (aOR = 1.1, 95% CI: 1.07–1.2) were associated with hospital admission or referral to a higher level of care.ConclusionsUltrasound is useful to detect plasma leakage in primary care and, challenges remain to guarantee high-quality images and diagnostic accuracy, for which a standardized dengue POCUS protocol and training program is needed.Graphical

Expression of global consensus non-structural protein 1 (NS1) of dengue virus serotypes 1 and 2 in Nicotiana benthamiana

Dengue viruses, which consist of four distinct serotypes, belong to the Flavivirus family, one of the most important arthropod-borne pathogen groups for humans. Vietnam is among the tropical countries that have endemic dengue outbreaks, and in 2022, the number of infections as well as fatal cases reached a record high, causing a great economic burden to the public health system. Although all four dengue serotypes have been circulating in Vietnam, serotypes 1 and 2 have been dominating in the last few decades. Since most dengue clinical complications result from secondary infection with a different serotype from the first infection, prior knowledge of the proportion of a population having seropositive to a certain serotype is very crucial for public health policy makers. The absence of comprehensive and regular serological epidemiological surveys in Vietnam has impeded progress in surveillance and the implementation of effective preventive measures. To facilitate research into dengue treatment and diagnosis, we created two synthetic, codon-optimized genes encoding for global consensus non-structural protein 1 (NS1) from dengue serotypes 1 and 2. We expressed these genes in Nicotiana benthamiana using the agroinfiltration technique. Western blot using Dengue patients’ sera indicated that the target proteins were expressed, likely in both mono and multimeric forms. Our results indicated that N. benthamiana is a good alternative to other methods of producing recombinant NS1.

Unmasking the Hidden Threat of Cardiac Involvement in Dengue Fever: A Critical Longitudinal Study.

Dengue fever (DF) arises from the dengue virus (DENV), a common viral illness transmitted by arthropods. This medical condition has the potential to result in severe complications, including but not limited to liver failure, disseminated intravascular coagulation, dengue encephalopathy, myocarditis, acute renal failure, and hemolytic uremic syndrome. Evaluating cardiac manifestations in dengue is crucial for timely intervention and intensive care to save patients' lives. A longitudinal study involved 104 dengue fever patients admitted to the Department of Medicine at New Civil Hospital, Surat, between May 2021 and October 2021, to identify potential cardiac involvement. The study found that out of the 104 patients, 28 (26.92%) showed cardiac involvement based on clinical manifestations. Among these patients, 28 (26.92%) exhibited abnormal ECG results, and 39 (37.50%) showed elevated creatine kinase-MB (CK-MB) levels. Of the 28 patients who showed ECG changes, 14 (50%) displayed abnormal 2D-echocardiography (ECHO) results. The most common electrocardiographic anomaly was a T-wave inversion in V1-V4. The predominant 2D-ECHO finding was mild pericardial effusion. Cardiac involvement in dengue presents atypically and can lead to conditions like myocarditis, arrhythmias, cardiac failure, or shock. Assessing cardiac manifestations in dengue patients is pivotal for appropriate management.

Aspergillus coinfection in critically Ill patients with severe dengue

In 2014–2015, a significant outbreak of dengue fever occurred in southern Taiwan, with a subsequent decline in dengue incidence. Despite this, there is emerging concern about virus-associated aspergillosis, yet limited research has explored coinfections involving dengue and aspergillosis. We conducted a retrospective study at a single center in Southern Taiwan, specifically focusing on dengue patients admitted to the intensive care unit during the period between July and November 2015. Among the 142 dengue patients studied, only 8.06 % (10/142) underwent serum galactomannan testing, with a single patient undergoing bronchoalveolar lavage (BAL) galactomannan assay. Out of those tested, 20 % (2/10) returned positive serum galactomannan results. Herein, we present two consecutive cases of coinfection involving dengue and pulmonary aspergillosis in immunocompetent patients.

Anaesthetic management of pregnant patients with severe dengue fever for emergency caesarean section - A case series and review

: Dengue, a mosquito-borne viral infection, can lead to severe complications like dengue shock syndrome and severe thrombocytopenia. Pregnant patients with dengue present unique anaesthetic challenges. In this case series, we present the anaesthetic management of four pregnant patients with dengue who required emergency caesarean delivery.: All patients had severe thrombocytopenia and required platelet transfusions. Two patients developed respiratory distress and pulmonary edema in the perioperative period. One patient had severe liver function abnormalities along with thrombocytopenia, complicating the diagnosis. All patients received intensive care unit (ICU) management. None of the neonates tested positive for dengue.: The pathophysiological changes of pregnancy and dengue infection complicate the anaesthetic management of critically ill dengue patients. Thrombocytopenia and abnormal immune response lead to acute vascular permeability, plasma leakage, circulatory insufficiency, and polyserositis. Abnormal liver function tests and thrombocytopenia must be differentiated from HELLP syndrome. Over-transfusion of fluids due to shock can lead to pulmonary edema.: Pregnant patients with dengue fever pose a high risk of maternal and foetal mortality and morbidity. Successful anaesthetic management requires judicious transfusion of blood products and fluids based on the disease's complications and stage of illness. General anaesthesia is safe in these patients.

Prevalence of acute kidney injury among dengue cases: a systematic review and meta-analysis.

Numerous studies have shown a correlation between dengue virus (DENV) infection and kidney disease. However, there is no existing meta-analysis on the prevalence of kidney diseases in the dengue population. A thorough systematic review and meta-analysis were undertaken to determine the prevalence of renal problems in people with DENV infection in order to fill this knowledge gap. A rigorous electronic literature search was carried out up to 25 January 2023 in a number of databases, including ProQuest, EBSCOhost, Scopus, PubMed and Web of Science. The search aimed to find articles that reported on the prevalence of kidney diseases in patients with DENV infection. Using the modified Newcastle-Ottawa Scale, the quality of the included studies was assessed. The meta-analysis included a total of 37 studies with 21764 participants reporting on the prevalence of acute kidney injury (AKI) in individuals with DENV infection. The pooled prevalence of AKI in dengue patients was found to be 8% (95% confidence interval 6 to 11), with high heterogeneity across studies. The studies included are of moderate quality. The study revealed a high AKI prevalence in dengue patients, underlining the need for regular renal examination to detect AKI early and reduce hospitalization risk. Further research is needed to understand the dengue-kidney relationship and develop effective management strategies.

Observational study of using lactate dehydrogenase as prognostic marker in dengue patients

BackgroundDengue is one of the common mosquito borne illness in south India and it is nearly endemic in coastal regions of state of Andhra Pradesh (AP). In view of high incidence during monsoon season with substantial mortality, department of Internal Medicine in Visakhapatnam performed a study where serum Lactate dehydrogenase levels were used as biomarker to predict severity of dengue infection to avoid complications and mortality. MethodsThe study was an unicentric, open labelled, observational prospective study conducted in tertiary hospital in the city of Visakhapatnam. All the patients who were serologically tested with Dengue positive status during June 2022 to December 2022 were included in the study. ResultsThe correlation between lactate dehydrogenase (LDH) levels at the time of presentation and severity of disease is linear in nature with Pearson's coefficient of correlation (R) 0.778. The linear correlation was statistically significant with P value < 0.01. The correlation between LDH levels at the time of presentation and platelet count at time of admission was inversely proportional with Pearson's coefficient of correlation (R) - 0.326. ConclusionThe main finding of the study is that LDH levels at the time of diagnosis in dengue patients can predict complications during course of illness.

A Retrospective Seroprevalence Study of Dengue, Chikungunya and Co-Infection virus: a Hospital Based Study from Theni, Tamil Nadu

Viral-borne diseases have recently gained significant public health importance in the current world. The Viral Research and Diagnostic Laboratory (VRDL) located at Government Theni Medical College (GTMC), Theni, Tamil Nadu, conducts the diagnosis of common virus infections. The purpose of this study is to investigate the seroprevalence of dengue (DENV) and chikungunya (CHIKV) virus infections, as well as their co-infection, in people who have clinical symptoms. From January 2018 to June 2023, serum samples were collected from clinically suspected patients at the tertiary care hospital in Theni, Tamil Nadu. DENV and CHIKV were detected using an enzyme-linked immunosorbent assay (ELISA) in all of the samples. A total of 16,997 cases were enrolled, out of which 11264/2971(26.3%) tested positive for Dengue IgM, 1395/288 (20.6%) for Dengue NS1 Ag, 19/3(15.7%) for IgG, followed by 4319/3388(8.9%) of CHIKV IgM. Fever (n = 16598, 97.6%) was the most prevalent clinical characteristic in all probable dengue and chikungunya patients. Other symptoms were chills (n = 11252, 66.1%), arthralgia (n = 10245, 60.2%), headache (n = 11354, 66.8%), and joint pain (n = 11256, 66.2%). The findings showed a lesser likelihood of acquiring both DENV and CHIKV infections at the same time; however, the risk is still not trivial. This study investigates the clinical presentation of Dengue-Chikungunya patients. The rising prevalence of dengue and chikungunya, as well as their co-infection, need thorough monitoring of endemic areas and good patient care management.

To study ultrasound and chest X-ray findings and their role in the diagnosis of dengue fever in children.

Dengue fever is a fatal viral illness affecting almost all age groups and is seen in almost all tropical countries. Ultrasonography (USG) can be a useful tool for the assessment and diagnosis of dengue fever. The study aimed to evaluate X-ray and ultrasound findings in children with dengue fever. This was a prospective and cross-sectional study that was carried out in a hospital in Mumbai for over one year. All relevant data were collected, validated, and analyzed statistically on the software Epi Info 7. Abnormal X-ray findings noticed were pleural effusion, pneumonia, and bilateral nodular opacities. Pleural effusion and respiratory complications were more common in severe dengue (P < 0.05). Out of the 37 patients on whom USG was done, 33 (89.18%) had abnormal and 4 (10.81%) had normal USG findings. Of the 17 patients with dengue who showed warning signs, 16 (89.9%) had abnormal USG findings. Plasma leakage in the form of ascites and effusion was commonly seen. One hundred percent of patients with severe dengue had abnormal USG findings. The abnormal USG findings were more commonly detected between 5-7 days and were more commonly associated with IgG + IgM-positive serology. Ultrasonography is a good modality for the diagnosis and evaluation of dengue patients. Serial ultrasound should be done for the assessment and evaluation of said patients.

Do Hematocrit Levels Differentiate between Complicated and Uncomplicated Dengue Fever?

Objective: To compare mean hematocrit levels in patients with uncomplicated and complicated Dengue Fever and evaluate the role of hematocrit in differentiating uncomplicated and complicated Dengue Fever.&#x0D; Study Designs: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Infectious Diseases, Holy Family Hospital, Rawalpindi Pakistan, from Oct 2019 to Sep 2020.&#x0D; Methodology: Around 240 dengue patients were enrolled. Hematocrit level at presentation was measured using an automated haematology analyzer. The patients were then followed for the development of complications (Dengue hemorrhagic fever and Dengue shock syndrome).&#x0D; Results: Of 240 patients, 183(76.2%) were male, and 57(23.8%) were female. Dengue Fever was present in 96(40%) patients, whereas 144(60%) patients developed complications (Dengue Hemorrhagic Fever and Dengue Shock Syndrome). The mean hematocrit level at presentation significantly differed among the groups (p=0.012). Following the ROC curve analysis, for the cut-off value of 42.6% of hematocrit Group II had a sensitivity of 56.25% and a specificity of 62.5% at an Area under the curve of 0.589.&#x0D; Conclusion: The mean hematocrit levels were significantly higher in patients with complicated versus uncomplicated Dengue Fever. Hematocrit could not be projected as a predictor of Dengue Fever severity.

Early transcriptomic host response signatures in the serum of dengue patients provides insights into clinical pathogenesis and disease severity

Dengue virus (DENV), known to cause viral infection, belongs to the family Flaviviridae, having four serotypes (DENV1-4) that spreads by the bite of the Aedes aegypti mosquito. India has been suffering from dengue outbreaks annually with widespread epidemics by prevalence of all the four DENV serotypes. The diverse spectrum of clinical manifestations in dengue infection, mild to severe forms, makes the need of timely diagnosis and prompt treatment an essence. The identification of a dengue host response signature in serum can increase the understanding of dengue pathogenesis since most dengue NS1 Ag tests have been developed and evaluated in serum samples. Here, to understand the same, we undertook a dual RNA-sequencing (RNA-Seq) based approach from the serum samples of dengue-infected patients. The results thus yield the early transcriptional signatures that discriminated the high viral reads patients from patients who had low dengue viral reads. We identified a significant upregulation of two sets of genes, key antiviral (IFIT3, RSAD2, SAT1) and vascular dysfunction (TNFS10, CXCL8) related genes in the high viral reads group. Deeper delving of this gene profile revealed a unique two-way response, where the antiviral genes can mediate the disease course to mild, contrarily the increased expression of the other gene set might act as pointers of severe disease course. Further, we explored the hematologic parameters from the complete blood count (CBC), which suggests that lymphocytes (low) and neutrophils (high) might serve as an early predictor of prognosis in dengue infection. Collectively, our findings give insights into the foundation for further investigation of the early host response using the RNA isolated from dengue patients’ serum samples and opens the door for careful monitoring of the early clinical and transcriptome profiles for management of the dengue patients.

Potential of Carica papaya leaf extract as an future medicine for thrombocytopenia in dengue patients: from traditional to scientific drug discovery

Potential of Carica papaya leaf extract as an future medicine for thrombocytopenia in dengue patients: from traditional to scientific drug discovery

A predictive score for severity in patients with confirmed dengue fever in a tertiary care hospital in Kerala, India.

The study aimed to identify predictors of severe dengue during the 2017 epidemic and to develop and validate a simple predictive score for severity. A retrospective analytical study was conducted using clinical and laboratory data from adult dengue patients with a confirmed microbiological diagnosis. The study included patients who presented to a tertiary care centre in Kerala, India, during the febrile phase (≤4d) between June 2017 and February 2019. Using appropriate statistical tests, we derived predictors of severe disease and computed a risk score model. Of the 153 patients (mean age 50±17y; 64% males), 31 (20%) had severe dengue and 4 (3%) died. Petechial lesions, hypoalbuminemia (<3.5 g/dl), elevated alanine aminotransferase (>40IU/l) and urea >40IU/l were significant predictors. Our scoring system (cut-off: 2) showed excellent performance, with an area under the receiver operating characteristics curve of 0.9741, sensitivity of 100%, specificity of 96% and accuracy of 98%. The risk score was secondarily validated on 48 patients hospitalized from March 2019 to June 2019. Our scoring system is easy to implement and will help primary healthcare practitioners in promptly identifying severe dengue cases upon hospital presentation.

Geographic Accessibility to Primary Healthcare: Study Case Dengue Fever in Purwosari Sub-District, Gunungkidul Regency, Yogyakarta, Indonesia

Distribution and spatial analysis of public healthcare in Indonesia are rarely discussed. Most of the research tell about quantity and quality which do not mention the spatial aspect. This research purposes to know the relationship between health facilities selection and geographic conditions by combining medical facilites data, number of doctor and spatial analysis approach. The selected study areas are referral health facilities chosen by DHF (Dengue Hemorrhagic Fever) patients in Purwosari District, Gunungkidul Regency. Information was collected by interviews and field measurements (altitude and location plotting) and also secondary data collection (hospital accreditation data, number of doctors, and number of beds). GPS, Altimeter, ArcGIS, and SPSS used for data collection and analysis. The spatial analysis method in this research were kernel density, buffer, ruler, and altitude of each facility. Meanwhile, the medical analysis approach used Pearsons' correlation and multinomial logistic regression in SPSS. The results of the spatial analysis show that the DHF patients in Purwosari dominantly choose health facilities in Bantul Regency because of having closer distance, relatively short travel time, lower elevation, and many health facilities centers. At the same time, Puskesmas Purwosari (Sub-district level Health center) was only chosen as an early reference and a place for treating mild dengue patients. In addition, distance, duration of travel time, and the number of doctors had a strong correlation based on the Pearson's correlation. These three variables have the greatest linear relationship with the response variable. Meanwhile, some variables; elevation, number of doctors, accreditation, and number of beds were considered by patients in choosing a hospital based on multinomial logistic regression analysis.