No abstract

Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.

Background: Asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections are well documented. Healthcare workers (HCW) are at increased risk of infection due to occupational exposure to infected patients. We aim to determine the prevalence of SARS-CoV-2 antibodies among HCW who did not come to medical attention. Methods:We prospectively recruited 400 HCW from the National Public Health Laboratory and two COVID-19 designated public hospitals in Klang Valley, Malaysia between 13/4/2020 and 12/5/2020. Quota sampling was used to ensure representativeness of HCW involved in direct and indirect patient care. All participants answered a self-administered questionnaire and blood samples were taken to test for SARS-CoV-2 antibodies by surrogate virus neutralization test. Findings:The study population comprised 154 (38.5%) nurses, 103 (25.8%) medical doctors, 47 (11.8%) laboratory technologists and others (23.9%). A majority (68.9%) reported exposure to SARS-CoV-2 in the past month within their respective workplaces. Adherence to personal protection equipment (PPE) guidelines and hand hygiene were good, ranging from 91-100% compliance. None (95% CI: 0, 0.0095) of the participants had SARS-CoV-2 antibodies detected, despite 182 (45.5%) reporting some symptoms one month prior to study recruitment. One hundred and fifteen (29%) of participants claimed to have had contact with known COVID-19 persons outside of their workplace.Interpretation: Zero seroprevalence among HCW suggests a low incidence of undiagnosed COVID-19 infection in our healthcare setting during the first local wave of SARS-CoV-2 infection. The occupational risk of SARS-CoV-2 transmission within healthcare facilities can be prevented by adherence to infection control measures and appropriate use of PPE.

Introduction: Dengue fever has spread to be endemic in addition of 100 countries to a total estimate incidence of 50 – 100 million cases annually globally. About 0.7% of these cases become the complication that is dengue hemorrhagic fever which is severe and leads to about 22,000 deaths annually. The pathogenesis of benign dengue fever becoming dengue hemorrhagic fever, and aspects of the immune-response behind it, have remained relatively unknown. Methods: Existing literature on the Topic was retrieved through Google Scholar and PubMed searches, and the literature reviewed. Results: Dengue hemorrhagic fever appears commoner in females and those with co-morbids such as diabetes-mellitus and obesity. Also, the case-fatality rate in severe dengue appears much bigger in females. The reasons for this are largely unknown but the additionally robust immune response in females, resulting in females to be additionally prone to develop bigger inflammatory response or enhanced susceptibility to capillary permeability could be the reason. It has been shown that viremic-load, including the initial viremic-load at the bite of the Aedes-mosquito may be a factor leading to dengue hemorrhagic fever. Yet different factors felt to be causative in the pathogenesis of dengue hemorrhagic fever include the role of the viral-protein, and then that which is termed the original antigenic-sin, the antibody-directed enhancement, autoimmunity, inhibition of interferon-alpha and cytokine-storm within the memory-cells. Regionally, certain different strains of the DENV also seem to be associated with dengue hemorrhagic fever. Newer-vaccines, based on the immunology of the disease, offer much hope in the near future. Conclusion: Much knowledge has been forthcoming in realizing the pathogenesis of dengue hemorrhagic fever. But, additional studies need to be done.

Background Available data on influenza burden across Southeast Asia are largely limited to pediatric populations, with inconsistent findings. Methods We conducted a multicenter, hospital-based active surveillance study of adults in Malaysia with community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute exacerbation of asthma (AEBA), who had influenza-like illness ≤10 days before hospitalization. We estimated the rate of laboratory-confirmed influenza and associated complications over 13 months (July 2018–August 2019) and described the distribution of causative influenza strains. We evaluated predictors of laboratory-confirmed influenza and severe clinical outcomes using multivariate analysis. Results Of 1106 included patients, 114 (10.3%) were influenza-positive; most were influenza A (85.1%), with A/H1N1pdm09 being the predominant circulating strain during the study following a shift from A/H3N2 from January–February 2019 onwards. In multivariate analyses, an absence of comorbidities (none versus any comorbidity [OR (95%CI), 0.565 (0.329–0.970)], p = 0.038) and of dyspnea (0.544 (0.341–0.868)], p = 0.011) were associated with increased risk of influenza positivity. Overall, 184/1106 (16.6%) patients were admitted to intensive care or high-dependency units (ICU/HDU) (13.2% were influenza positive) and 26/1106 (2.4%) died (2.6% were influenza positive). Males were more likely to have a severe outcome (ICU/HDU admission or death). Conclusions Influenza was a significant contributor to hospitalizations associated with CAP, AECOPD and AEBA. However, it was not associated with ICU/HDU admission in this population. Study registration, NMRR ID: NMRR-17-889-35,174.