Using clinical practice guidelines to manage dengue: a qualitative study in a Malaysian hospital

Acute Hemorrhagic Pancreatitis as a Rare Complication of Dengue Fever

Dengue fever can lead to a range of symptoms, including severe manifestations such as dengue hemorrhagic fever. We report a rare case of severe dengue with hemorrhagic pancreatitis and pseudocyst formation in a 28-year-old woman. Initially presenting with fever, abdominal pain, and gastrointestinal symptoms, the patient developed worsening pain, vomiting, and an abdominal mass. Imaging revealed a pancreatic mass, and elevated amylase and lipase confirmed pancreatitis. Interventional radiology drained the hemorrhagic fluid from the suspected pseudocyst, leading to patient improvement and eventual discharge. This uncommon complication of acute hemorrhagic pancreatitis in dengue fever has not been previously documented.

Chemical Composition, Larvicidal and Repellent Activities of Wild Plant Essential Oils against Aedes aegypti

Bio-degradable and eco-friendly essential oils (EOs) extracted from Mentha longifolia, Salsola imbricata, Erigeron bonariensis, E. canadensis, Ailanthus altissima, and Zanthoxylum armatum were investigated for their repellent and larvicidal potential against Aedes aegypti mosquitoes. The EOs of M. longifolia, S. imbricata, E. bonariensis, E. canadensis, A. altissima, and Z. armatum exhibited 99.0%, 96.8%, 40.2%, 41.7%, 29.1%, and 13.2% repellency against mosquitoes at a tested dose of 33.3 μg/cm², respectively. In time span bioassays, the EOs of M. longifolia, S. imbricata, E. bonariensis, and E. canadensis showed more than 40% repellency for 60 min at a tested dose of 330 μg/cm². Larvicidal bioassays revealed that larvae of Ae. aegypti were the most susceptible to M. longifolia (LC₅₀, 39.3 mg/L), E. bonariensis (LC₅₀, 26.0 mg/L), E. canadensis (LC₅₀, 35.7 mg/L), and Z. armatum (LC₅₀, 35.9 mg/L) EOs upon 48 h exposure. The most abundant constituents in the EOs of M. longifolia, S. imbricata, E. bonariensis, E. canadensis and A. altissima were piperitone oxide (45.5%), carvone (39.9%), matricaria ester (43.1%), (31.7%) and eugenol (24.4%), respectively. Our study demonstrates that EOs of M. longifolia, S. imbricata, E. bonariensis, and E. canadensis might be used to control Ae. aegypti mosquitoes without harming humans or the environment.

Síntesis de evidencia: Directrices para el diagnóstico y el tratamiento del dengue, el chikunguña y el zika en la Región de las Américas

Introducción.

El dengue, el chikunguña y el zika son enfermedades virales que representan una amenaza constante a la salud pública. Las tres arbovirosis pueden producir un cuadro clínico muy similar, lo que representa un desafío para lograr un diagnóstico clínico adecuado y puede conllevar a un inadecuado manejo y generar eventos fatales. La guía Directrices para el diagnóstico y el tratamiento del dengue, el chikunguña y el zika es parte del esfuerzo de la Organización Panamericana de la Salud y los países de la Región de las Américas para evitar los casos graves y la muerte por estas enfermedades, en medio de un complejo panorama epidemiológico donde la presencia de múltiples factores favorece la dinámica de transmisión y ocasiona brotes y epidemias en los países de la Región.

Objetivos.

Sintetizar las recomendaciones incluidas en dicha guía, publicada por la OPS en 2022, con el fin de presentar el adecuado diagnóstico y tratamiento de estas arbovirosis y abordar aspectos sobre la implementación de las recomendaciones.

Métodos.

Se llevó a cabo una síntesis de la guía y sus recomendaciones. Adicionalmente, se realizó una búsqueda sistemática en Pubmed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en América Latina y el Caribe con el fin de identificar barreras, facilitadores y estrategias de implementación. Se identificaron y construyeron indicadores de proceso y de resultado de la implementación de las recomendaciones.

Resultados.

Se presentan 12 recomendaciones aplicables a pacientes adultos y pediátricos con sospecha o confirmación de dengue, chikunguña o zika. Se presentan barreras, facilitadores y estrategias para su implementación.

Conclusiones.

Las recomendaciones proveen estrategias para el diagnóstico y el tratamiento oportunos de casos agudos de dengue, chikunguña y zika, así como consideraciones para su implementación.

Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies

This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.

Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines

BACKGROUND

The World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines.

METHODS

A grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding.

RESULTS

We categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines.

CONCLUSIONS

In comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances.

ETHICS

This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).

<p>Repurposing of N-Acetylcysteine for the Treatment of Dengue Virus-Induced Acute Liver Failure</p>

The prevalence of dengue infection-induced acute liver damage is increasing from time to time. Since it has no specific antiviral treatment in the world, people in endemic areas suffer more from dengue disorders. Thus, there is a need for searching options for the treatment of dengue-induced acute liver failure. N-acetylcysteine, which is used for the treatment of nasal congestion disorder and paracetamol overdose toxicity, could be used as a definitive therapy for dengue virus-induced acute liver disease. Therefore, this review discusses the therapeutic use of N-acetylcysteine for dengue-induced acute liver disease. Various case reports and case series showed that patients received NAC recovered from their clinical status. Additionally, a preclinical study showed that N-acetylcysteine has anti-dengue virus activity. Thus, N-acetylcysteine could be used as a definitive therapy in dengue virus-induced hepatitis. This might encourage researchers to further investigate the importance of N-acetylcysteine for dengue virus-induced hepatitis.