61 results found
McBride A, Mehta P, Rivino L, et al., 2021, Targeting hyperinflammation in infection: can we harness the COVID-19 therapeutics momentum to end the dengue drugs drought? Comment, LANCET MICROBE, Vol: 2, Pages: E277-E278, ISSN: 2666-5247
Sangkaew S, Ming D, Boonyasiri A, et al., 2021, Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis, Lancet Infectious Diseases, Vol: 21, Pages: 1014-1026, ISSN: 1473-3099
BACKGROUND: The ability to accurately predict early progression of dengue to severe disease is crucial for patient triage and clinical management. Previous systematic reviews and meta-analyses have found significant heterogeneity in predictors of severe disease due to large variation in these factors during the time course of the illness. We aimed to identify factors associated with progression to severe dengue disease that are detectable specifically in the febrile phase. METHODS: We did a systematic review and meta-analysis to identify predictors identifiable during the febrile phase associated with progression to severe disease defined according to WHO criteria. Eight medical databases were searched for studies published from Jan 1, 1997, to Jan 31, 2020. Original clinical studies in English assessing the association of factors detected during the febrile phase with progression to severe dengue were selected and assessed by three reviewers, with discrepancies resolved by consensus. Meta-analyses were done using random-effects models to estimate pooled effect sizes. Only predictors reported in at least four studies were included in the meta-analyses. Heterogeneity was assessed using the Cochrane Q and I2 statistics, and publication bias was assessed by Egger's test. We did subgroup analyses of studies with children and adults. The study is registered with PROSPERO, CRD42018093363. FINDINGS: Of 6643 studies identified, 150 articles were included in the systematic review, and 122 articles comprising 25 potential predictors were included in the meta-analyses. Female patients had a higher risk of severe dengue than male patients in the main analysis (2674 [16·2%] of 16 481 vs 3052 [10·5%] of 29 142; odds ratio [OR] 1·13 [95% CI 1·01-1·26) but not in the subgroup analysis of studies with children. Pre-existing comorbidities associated with severe disease were diabetes (135 [31·3%] of 431 with vs 868 [16·0%] of 5421 witho
ISARIC Clinical Characterisation Group, 2021, COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study, Infection: journal of infectious disease, ISSN: 0300-8126
BACKGROUND: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. METHODS: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. RESULTS: 'Typical' symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. INTERPRETATION: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.
Nguyen LV, Phung KL, Ming DKY, et al., 2021, Combination of inflammatory and vascular markers in the febrile phase of dengue is associated with more severe outcomes, ELIFE, Vol: 10, ISSN: 2050-084X
Nguyen LV, Nguyen THQ, Nguyen THT, et al., 2021, Higher Plasma Viremia in the Febrile Phase Is Associated With Adverse Dengue Outcomes Irrespective of Infecting Serotype or Host Immune Status: An Analysis of 5642 Vietnamese Cases, CLINICAL INFECTIOUS DISEASES, Vol: 72, Pages: E1074-E1083, ISSN: 1058-4838
Li Bassi G, Suen JY, Dalton HJ, et al., 2021, An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients, CRITICAL CARE, Vol: 25, ISSN: 1364-8535
Pham QT, Rabaa MA, Duong HL, et al., 2021, The First 100 Days of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Control in Vietnam, CLINICAL INFECTIOUS DISEASES, Vol: 72, Pages: E334-E342, ISSN: 1058-4838
Haymet AB, Bartnikowski N, Wood ES, et al., 2021, Studying the Endothelial Glycocalyx in vitro: What Is Missing?, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 8, ISSN: 2297-055X
Chau NVV, Hai HB, Greeff H, et al., 2021, Wearable remote monitoring for patients with COVID-19 in low-resource settings: case study, BMJ Innovations, Vol: 7, Pages: s12-s15, ISSN: 2055-8074
McBride A, Chanh HQ, Fraser JF, et al., 2020, Microvascular dysfunction in septic and dengue shock: Pathophysiology and implications for clinical management., Glob Cardiol Sci Pract, Vol: 2020, ISSN: 2305-7823
The microcirculation comprising of arterioles, capillaries and post-capillary venules is the terminal vascular network of the systemic circulation. Microvascular homeostasis, comprising of a balance between vasoconstriction, vasodilation and endothelial permeability in healthy states, regulates tissue perfusion. In severe infections, systemic inflammation occurs irrespective of the infecting microorganism(s), resulting in microcirculatory dysregulation and dysfunction, which impairs tissue perfusion and often precedes end-organ failure. The common hallmarks of microvascular dysfunction in both septic shock and dengue shock, are endothelial cell activation, glycocalyx degradation and plasma leak through a disrupted endothelial barrier. Microvascular tone is also impaired by a reduced bioavailability of nitric oxide. In vitro and in vivo studies have however demonstrated that the nature and extent of microvascular dysfunction as well as responses to volume expansion resuscitation differ in these two clinical syndromes. This review compares and contrasts the pathophysiology of microcirculatory dysfunction in septic versus dengue shock and the attendant effects of fluid administration during resuscitation.
Nguyen VVC, Vo TL, Nguyen TD, et al., 2020, The Natural History and Transmission Potential of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection, CLINICAL INFECTIOUS DISEASES, Vol: 71, Pages: 2679-2687, ISSN: 1058-4838
Zellweger RM, Yacoub S, Chan YFZ, et al., 2020, Disentangling etiologies of CNS infections in Singapore using multiple correspondence analysis and random forest, SCIENTIFIC REPORTS, Vol: 10, ISSN: 2045-2322
Phung KL, McBride A, Duyen HTL, et al., 2020, Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity, FRONTIERS IN MEDICINE, Vol: 7
, 2020, Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries, CRITICAL CARE, Vol: 24, ISSN: 1364-8535
Gan ES, Tan HC, Duyen HTL, et al., 2020, Dengue virus induces PCSK9 expression to alter antiviral responses and disease outcomes, JOURNAL OF CLINICAL INVESTIGATION, Vol: 130, Pages: 5223-5234, ISSN: 0021-9738
Gallagher P, Chan KR, Rivino L, et al., 2020, The association of obesity and severe dengue: possible pathophysiological mechanisms, JOURNAL OF INFECTION, Vol: 81, Pages: 10-16, ISSN: 0163-4453
Ming DK, Sorawat S, Chanh HQ, et al., 2020, Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses, International Journal of Infectious Diseases, Vol: 96, Pages: 648-654, ISSN: 1201-9712
Optimal management of infectious diseases is guided by up-to-date information at the individual and public health level. For infections of global importance including emerging pandemics such as COVID-19 or prevalent endemic diseases such like dengue, identifying patients at risk of severe disease and clinical deterioration can be challenging given the majority present with a mild illness. In our article, we describe the use of wearable technology for continuous physiological monitoring in healthcare. Deployment of wearables in hospital settings for the management of infectious diseases, or in the community to support syndromic surveillance during outbreaks could provide significant, cost effective advantages and improve healthcare delivery. We highlight a range of promising technologies employed by wearable devices and discuss the technical and ethical issues relating to implementation in the clinic, with specific focus on low- and middle- income countries. Finally, we propose a set of essential criteria for the roll-out of wearable technology for clinical use.
Sanz MG, De Sario V, Garcia-Mingo A, et al., 2020, Chagas disease in the United Kingdom: A review of cases at the Hospital for Tropical Diseases London 1995-2018. The current state of detection of Chagas disease in the UK, TRAVEL MEDICINE AND INFECTIOUS DISEASE, Vol: 36, ISSN: 1477-8939
Redoni M, Yacoub S, Rivino L, et al., 2020, Dengue: Status of current and under-development vaccines, REVIEWS IN MEDICAL VIROLOGY, Vol: 30, ISSN: 1052-9276
Nguyen LV, Huynh TLD, Phung KL, et al., 2020, C-reactive protein as a potential biomarker for disease progression in dengue: a multi-country observational study, BMC MEDICINE, Vol: 18, ISSN: 1741-7015
Yacoub S, Nguyen NM, Chanh HQ, et al., 2020, Metformin as adjunctive therapy for dengue in overweight and obese patients: A protocol for an open-label clinical trial (MeDO), Wellcome Open Research, Vol: 5
Background: Dengue is a disease of major global importance. While most symptomatic infections are mild, a small proportion of patients progress to severe disease with risk of hypovolaemic shock, organ dysfunction and death. In the absence of effective antiviral or disease modifying drugs, clinical management is solely reliant on supportive measures. Obesity is a growing problem among young people in Vietnam and is increasingly recognised as an important risk factor for severe dengue, likely due to alterations in host immune and inflammatory pathways. Metformin, a widely used anti-hyperglycaemic agent with excellent safety profile, has demonstrated potential as a dengue therapeutic in vitro and in a retrospective observational study of adult dengue patients with type 2 diabetes. This study aims to assess the safety and tolerability of metformin treatment in overweight and obese dengue patients, and investigate its effects on several clinical, immunological and virological markers of disease severity. Methods: This open label trial of 120 obese/overweight dengue patients will be performed in two phases, with a metformin dose escalation if no safety concerns arise in phase one. The primary endpoint is identification of clinical and laboratory adverse events. Sixty overweight and obese dengue patients aged 10-30 years will be enrolled at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Participants will complete a 5-day course of metformin therapy and be compared to a non-treated group of 60 age-matched overweight and obese dengue patients. Discussion: Previously observed antiviral and immunomodulatory effects of metformin make it a promising dengue therapeutic candidate in appropriately selected patients. This study will assess the safety and tolerability of adjunctive metformin in the management of overweight and obese young dengue patients, as well as its effects on markers of viral replication, endothelial dysfunction and host immune responses. Trial
Nguyen NM, Chanh HQ, Tam DTH, et al., 2020, Metformin as adjunctive therapy for dengue in overweight and obese patients: a protocol for an open-label clinical trial (MeDO)., Wellcome Open Res, Vol: 5, ISSN: 2398-502X
Background: Dengue is a disease of major global importance. While most symptomatic infections are mild, a small proportion of patients progress to severe disease with risk of hypovolaemic shock, organ dysfunction and death. In the absence of effective antiviral or disease modifying drugs, clinical management is solely reliant on supportive measures. Obesity is a growing problem among young people in Vietnam and is increasingly recognised as an important risk factor for severe dengue, likely due to alterations in host immune and inflammatory pathways. Metformin, a widely used anti-hyperglycaemic agent with excellent safety profile, has demonstrated potential as a dengue therapeutic in vitro and in a retrospective observational study of adult dengue patients with type 2 diabetes. This study aims to assess the safety and tolerability of metformin treatment in overweight and obese dengue patients, and investigate its effects on several clinical, immunological and virological markers of disease severity. Methods: This open label trial of 120 obese/overweight dengue patients will be performed in two phases, with a metformin dose escalation if no safety concerns arise in phase one. The primary endpoint is identification of clinical and laboratory adverse events. Sixty overweight and obese dengue patients aged 10-30 years will be enrolled at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Participants will complete a 5-day course of metformin therapy and be compared to a non-treated group of 60 age-matched overweight and obese dengue patients. Discussion: Previously observed antiviral and immunomodulatory effects of metformin make it a promising dengue therapeutic candidate in appropriately selected patients. This study will assess the safety and tolerability of adjunctive metformin in the management of overweight and obese young dengue patients, as well as its effects on markers of viral replication, endothelial dysfunction an
Gan P, Yacoub S, 2019, Picturing health: dengue in Vietnam, LANCET, Vol: 394, Pages: 2059-2066, ISSN: 0140-6736
Hung TM, Wills B, Clapham HE, et al., 2019, The uncertainty surrounding the burden of post-acute consequences of dengue infection, Trends in Parasitology, Vol: 35, Pages: 673-676, ISSN: 0169-4758
Post-acute consequences currently form a significant component of the dengue disability-adjusted life year (DALY) burden estimates. However, there is considerable uncertainty regarding the incidence, duration, and severity of these symptoms. Further research is needed to more accurately estimate the health and economic burden of these dengue manifestations.
Turner HC, Nguyen VH, Yacoub S, et al., 2019, Achieving affordable critical care in low-income and middle-income countries, BMJ Global Health, Vol: 4, Pages: 1-4, ISSN: 2059-7908
Whitehorn J, Yacoub S, 2019, Global warming and arboviral infections, CLINICAL MEDICINE, Vol: 19, Pages: 149-152, ISSN: 1470-2118
Rodriguez-Manzano J, Chia PY, Yeo TW, et al., 2018, Improving Dengue Diagnostics and Management Through Innovative Technology (vol 20, 25, 2018), CURRENT INFECTIOUS DISEASE REPORTS, Vol: 20, ISSN: 1523-3847
Rodriguez-Manzano J, Ying Chia P, Wen Yeo T, et al., 2018, Improving Dengue diagnostics and management through innovative technology, Current Infectious Disease Reports, Vol: 20, ISSN: 1534-3146
Purpose of Review:Dengue continues to be a major global public health threat. Symptomatic infections can cause a spectrum of disease ranging from a mild febrile illness to severe and potentially life-threatening manifestations. Management relies on supportive treatment with careful fluid replacement. The purpose of this review is to define the unmet needs and challenges in current dengue diagnostics and patient monitoring and outline potential novel technologies to address these needs.Recent Findings:There have been recent advances in molecular and point-of-care (POC) diagnostics as well as technologies including wireless communication, low-power microelectronics, and wearable sensors that have opened up new possibilities for management, clinical monitoring, and real-time surveillance of dengue.Summary:Novel platforms utilizing innovative technologies for POC dengue diagnostics and wearable patient monitors have the potential to revolutionize dengue surveillance, outbreak response, and management at population and individual levels. Validation studies of these technologies are urgently required in dengue-endemic areas.
Morra ME, Altibi AMA, Iqtadar S, et al., 2018, Definitions for warning signs and signs of severe dengue according to the WHO 2009 classification: Systematic review of literature, REVIEWS IN MEDICAL VIROLOGY, Vol: 28, ISSN: 1052-9276
Nguyen THM, Nguyen HP, Ho DTN, et al., 2018, Dengue-Associated Posterior Reversible Encephalopathy Syndrome, Vietnam, EMERGING INFECTIOUS DISEASES, Vol: 24, Pages: 402-404, ISSN: 1080-6040
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