Retrospective analysis of dengue mortalities over a 32 month period in a state hospital, Malaysia

Abstract

Background: Hepatitis B virus (HBV) genotypes distribution varies worldwide. Genotype determination is important in virus epidemiology and to predict progress of disease. Certain genotypes are reported to be associated with more severe disease and more frequent development of hepatocellular carcinoma. More data is required on the local HBV genotypes. This study aimed to determine the HBV genotypes among chronic hepatitis B patients who were on treatment in Universiti Kebangsaan Malaysia Medical Centre (UKMMC), and the association with demographics, laboratory and clinical parameters.Methods and materials: Cross-sectional study done at the Molecular Biology Unit, Department of Laboratory Diagnostics, UKMMC from January 2016 to March 2019. Plasma samples (n = 1760) received for HBV viral load were screened for volume adequacy and viral load of at least 1000 IU/mL (n = 61). Records were traced to include patients who were on treatment, no coinfection and no hepatocellular carcinoma. Real-time polymerase chain reaction with two-step melting curve analysis was done. Genotypes were determined for 50 samples. From the remaining 11 samples which the genotype could not be determined, 3 samples with good amplification curves were then sequenced, using the platform of ABI 3730 XL (Applied Biosystems). Data on patient demographics, viral load, alanine transaminase (ALT), HBeAg, anti-HBs, alpha-fetoprotein and cirrhosis were recorded. The association between genotypes and the parameters were then analysed.Results: A total of 53 samples were successfully genotyped while eight samples were non-typable (13.0%). Thirty-three were identified as genotype B (54.1%), 14 were genotype C (23.0%), 5 were genotype A (8.2%) and 1 was genotype D (1.6%). Thirty-seven patients were male (60.7%) and majority of patients were between age 40 and 64 (49.2%). Fifty patients were non-cirrhotic (82.0%), while nine were cirrhotic (14.8%). Of these, 2 were genotype B, 2 were genotype C and 1 was genotype A. ALT were within normal limits for 42 patients (68.9%). Anti-HBs were reactive in 2 patients (genotype B and genotype C each). There was no statistically significant association found between genotypes and patient demographics, viral load, ALT, HBeAg, anti-HBs, alpha-fetoprotein and cirrhosis.Conclusion: Genotype B is the most predominant genotype among the chronic hepatitis B patients who were on treatment, followed by genotype C.

Systematic review on factors of mortality among dengue patients in Malaysia

“…This observation might be due to females having a higher tendency to progress to having Dengue haemorrhagic fever (DHF)/ Dengue Shock Syndrome (DSS) with higher fatality numbers in comparison to males 13 . On the contrary, out of 15 mortality cases over 32 months seen in another retrospective study, 73% of them were males 14 . However, studies still have contradicting proof on the relation of gender with dengue mortality 6 .…”

“…Abdominal pain or tenderness was more frequently observed in adults 15 . Other than that, 60% of 15 mortality cases had pleural effusion while 61% developed ascites respectively, based on clinical, radiological signs and symptoms 14 .…”

“…For over 32 months, at a state hospital in Malaysia, a total of 15 samples that were associated with death were recorded, in which 80% had bleeding and leaking manifestation. A total number of 40% of cases had occult bleeding while 26.7% bled from the gastrointestinal system and oral cavity 14 . In another study, it is shown that nausea, vomiting, abdominal pain and fever were present in all death cases (100%) while pain behind the eyes and painful micturition presented in six out of eight patients (75%) 11 .…”

“…In a study conducted, 60% of 15 mortality cases presented with manifestations of pleural effusion while 61% of the cases developed Ascites accordingly. In cases who suffered from renal failure requiring them to undergo continuous renal replacement therapy (CRRT) accounted for about 93.3% (n = 14) of mortalities, while 93.3% had severe hepatitis, 53% with myocarditis and 27% of mortalities cases had CNS (central nervous system) manifestations 14 .…”