Background. Early prediction of severe dengue could significantly assist patient triage and case management. Methods. We prospectively investigated 7563 children with ≤3 days of fever recruited in ...the outpatient departments of 6 hospitals in southern Vietnam between 2010 and 2013. The primary endpoint of interest was severe dengue (2009 World Health Organization Guidelines), and predefined risk variables were collected at the time of enrollment to enable prognostic model development. Results. The analysis population comprised 7544 patients, of whom 2060 (27.3%) had laboratory-confirmed dengue; nested among these were 117 (1.5%) severe cases. In the multivariate logistic model, a history of vomiting, lower platelet count, elevated aspartate aminotransferase (AST) level, positivity in the nonstructural protein 1 (NS1) rapid test, and viremia magnitude were all independently associated with severe dengue. The final prognostic model (Early Severe Dengue Identifier ESDI) included history of vomiting, platelet count, AST level. and NS1 rapid test status. Conclusions. The ESDI had acceptable performance features (area under the curve = 0.95, sensitivity 87% (95% confidence interval CI, 80%–92%), specificity 88% (95% CI, 87%–89%), positive predictive value 10% (95% CI, 9%–12%), and negative predictive value of 99% (95% CI, 98%–100%) in the population of all 7563 enrolled children. A score chart, for routine clinical use, was derived from the prognostic model and could improve triage and management of children presenting with fever in dengue-endemic areas.
Between 2010 and 2014, four chikungunya and two Zika virus infections were identified among 8,105 febrile children in southern Vietnam. Zika viruses were linked to French Polynesian strains, ...chikungunya to Cambodian strains. Against a backdrop of endemic dengue transmission, chikungunya and Zika present an additional arboviral disease burden in Vietnam.
Hypovolemic shock (dengue shock syndrome (DSS)) is the most common life-threatening complication of dengue. We conducted a genome-wide association study of 2,008 pediatric cases treated for DSS and ...2,018 controls from Vietnam. Replication of the most significantly associated markers was carried out in an independent Vietnamese sample of 1,737 cases and 2,934 controls. SNPs at two loci showed genome-wide significant association with DSS. We identified a susceptibility locus at MICB (major histocompatibility complex (MHC) class I polypeptide-related sequence B), which was within the broad MHC region on chromosome 6 but outside the class I and class II HLA loci (rs3132468, Pmeta = 4.41 × 10−11, per-allele odds ratio (OR) = 1.34 (95% confidence interval: 1.23-1.46)). We identified associated variants within PLCE1 (phospholipase C, epsilon 1) on chromosome 10 (rs3765524, Pmeta = 3.08 × 10−10, per-allele OR = 0.80 (95% confidence interval: 0.75-0.86)). We identify two loci associated with susceptibility to DSS in people with dengue, suggesting possible mechanisms for this severe complication of dengue.
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Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Dengue is the commonest arboviral disease of humans. An early and accurate diagnosis of dengue can support clinical management, surveillance and disease control and is central to achieving the World ...Health Organisation target of a 50% reduction in dengue case mortality by 2020.
5729 children with fever of <72 hrs duration were enrolled into this multicenter prospective study in southern Vietnam between 2010-2012. A composite of gold standard diagnostic tests identified 1692 dengue cases. Using statistical methods, a novel Early Dengue Classifier (EDC) was developed that used patient age, white blood cell count and platelet count to discriminate dengue cases from non-dengue cases.
The EDC had a sensitivity of 74.8% (95%CI: 73.0-76.8%) and specificity of 76.3% (95%CI: 75.2-77.6%) for the diagnosis of dengue. As an adjunctive test alongside NS1 rapid testing, sensitivity of the composite test was 91.6% (95%CI: 90.4-92.9%).
We demonstrate that the early diagnosis of dengue can be enhanced beyond the current standard of care using a simple evidence-based algorithm. The results should support patient management and clinical trials of specific therapies.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Non-invasive specimens for dengue diagnosis may be preferable where venous blood is difficult to collect and/or process, such as community-based or remote settings or when sampling from young ...children. We evaluated the performance of oral swabs and dried blood spots (DBS), compared with plasma, in diagnosing acute dengue and screening for past dengue virus (DENV) exposure. DENV-specific immunoglobulin (Ig) M, IgG, and NS1 antigen were detected both in oral swabs and DBS from acute patients. Oral swabs were less sensitive (IgM: 68.7%, IgG: 91.9%, NS1: 64.7%), but retained good specificity (100%, 92.3%, 95.8%, respectively) compared with plasma. DBS displayed high sensitivity (IgM: 100%, IgG: 96%, NS1: 100%) and specificity (IgM: 75%, IgG: 93%). DENV RNA was amplified from DBS (sensitivity 95.6%) but not from oral swabs. DENV-IgG (indicative of past flavivirus exposure) were detected with moderate sensitivity (61.1%) but poor specificity (50%) in oral swabs from healthy volunteers. Dried blood spots allow sensitive and specific diagnosis of acute dengue by serological, molecular, and antigen detection methods. Oral swabs may be an adequate alternative where blood cannot be collected.
Background. Dengue endangers billions of people in the tropical world, yet no therapeutic is currently available. In part, the severe manifestations of dengue reflect inflammatory processes affecting ...the vascular endothelium. In addition to lipid lowering, statins have pleiotropic effects that improve endothelial function, and epidemiological studies suggest that outcomes from a range of acute inflammatory syndromes are improved in patients already on statin therapy. Methods. Following satisfactory review of a short pilot phase (40 mg lovastatin vs placebo in 30 cases), we performed a randomized, double-blind, placebo-controlled trial of 5 days of 80 mg lovastatin vs placebo in 300 Vietnamese adults with a positive dengue NS1 rapid test presenting within 72 hours of fever onset. The primary outcome was safety. Secondary outcomes included comparisons of disease progression rates, fever clearance times, and measures of plasma viremia and quality of life between the treatment arms. Results. Adverse events occurred with similar frequency in both groups (97/151 64% placebo vs 82/149 55% lovastatin; P = .13), and were in keeping with the characteristic clinical and laboratory features of acute dengue. We also observed no difference in serious adverse events or any of the secondary outcome measures. Conclusions. We found lovastatin to be safe and well tolerated in adults with dengue. However, although the study was not powered to address efficacy, we found no evidence of a beneficial effect on any of the clinical manifestations or on dengue viremia. Continuing established statin therapy in patients who develop dengue is safe. Clinical Trials Registration. ISRCTN03147572.
Background: Hand, foot, and mouth disease (HFMD) is mostly benign, with patients recovering within a week. However, if the disease is caused by enterovirus A71 (EV-A71), it can cause major epidemics ...or outbreaks and can cause rapid death in children, and especially in young children. The aim of this study was to determine the association of clinical, laboratory characteristics, and viral infections with severe HFMD in children. Materials and methods: This case-control study was conducted on 280 pediatric patients diagnosed with HFMD admitted to The Children Hospital 1 and Tien Giang General Central Hospital. The study used a convenience method. Results: Clinical symptoms associated with severe HFMD included vomiting, high fever >39oC, rapid breathing, convulsions, rapid pulse >130 beats per minute, flounder, lethargy, drowsiness/coma, myoclonus/stumbling, apnea, and hiccup breathing. Laboratory features associated with severe HFMD included platelet count >400,000 cells/mm3 and blood glucose >180 mg/dL. The EV-A71 strain was associated with severe cases. The independent factors associated with severe HFMD were identified through the multivariate logistic regression model and including the carrier's gender, high fever >39oC, rapid pulse >130 beats/minute, platelet count >400,000/mm3, blood glucose >180 mg/dL, and EV-A71 infection. Conclusion: Implications are indicated for clinical and laboratory characteristics and viral types with severe hand, foot, and mouth disease in children.
Background: Red blood cell distribution width (RDW), a hematologic index, is a quantitative measure of the range in volume and size of red blood cells. Hyperglycemia in patients with type 2 diabetes ...is considered to promote the formation of glycosylated hemoglobin (HbA1C) and to shorten the lifespan of red blood cells by reducing their deformability and increasing their osmotic fragility and adhesiveness. Objectives: To evaluate the association between red cell distribution width (RDW), mean corpuscular volume (MCV), and mean corpuscular hemoglobin content (MCHC) of red blood cells and glycemic control in patients with type 2 diabetes. Methods: This retrospective study included 107 patients with type 2 diabetes who were undergoing treatment at Tien Giang General Hospital from April to August 2019. Gender, age, complete blood count, plasma glucose, HbA1C, cholesterol, and triglyceride data were collected. The patients were divided into two groups: group I (HbA1C less than or equal to 6.5-6.9%; n=51) and group II (HbA1C greater than or equal to 7.0%; n=56). Results: RWD was 13.32 for the group I and 13.95 for group II. MCHC was 32.21 for the group I and 32.84 for group II. RDW and MCHC were significantly higher in patients without good glycemic control (HbA1C greater than or equal to 7.0%) than with good HbA1C control (6.5-6.9%). RDW showed a significant correlation between glucose concentration and MCHC. HbA1C and MCHC were also significantly correlated. Conclusion: Good glycemic control is associated with lower RDW and MHC values in patients with type 2 diabetes. Therefore, RDW and MCHC can be used as prognostic markers to assist in blood glucose control in these patients. Keywords: Type 2 Diabetes, HbA1C, Red Blood Cell Distribution Width, Tien Giang
Background: Alagille syndrome (ALGS) is an autosomal dominant disorder that can affect the liver, heart, eyes, vertebrae, and face. ALGS is caused by mutations in the Notch signaling pathway members ...JAG1 or NOTCH2. The estimated prevalence of ALGS is 1 in 70,000 newborns. JAG1 gene mutations cause more than 90 percent of ALGS cases. This study aimed to determine the clinical, subclinical, and genetic mutation characteristics of ALGS in children in Vietnam. Materials and Methods: This cross-sectional study was conducted on all ALGS children treated in the Gastroenterology Department at Children's Hospital No. 1 from September 2014 to September 2017. Results: Of the 30 enrolled ALGS cases, most patients that came from other provinces, were admitted to hospital mainly due to jaundice, and showed no significant differences in age or sex. The clinical features included 96.67% hepatic abnormalities, 80% spinal abnormalities, and 86.67% characteristic ALGS facial features. Subclinical features included significant increases in direct bilirubin and gamma- glutamyl transferase (GGT) levels. JAG1 mutations were found in 73.33% of the cases and included missense (32%), nonsense (36%), frameshift (23%), and splice site (9%) mutations. The most frequent mutation position was exon 4 (23.33%), with the remainder located throughout the JAG1 gene. Conclusion: Children with ALGS most frequently showed hepatic abnormalities, skeletal abnormalities, and characteristic facial features. Direct bilirubin and GGT indexes were strongly increased in all cases. JAG1 mutation was the main cause of ALGS. ALGS is novel in Vietnam, so more research is needed. Keywords: Alagille syndrome, children, JAG1 mutation, hepatic disease, cardiac disease.
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