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Fluid management in children with severe dengue: a narrative review

Loi MV, Wang QY, Lee JH

Minerva Pediatr (Torino), 2023 Feb;75(1):49-61.
PMID: 36282485 DOI: 10.23736/S2724-5276.22.06935-X

Dengue is a mosquito-borne arboviral infection of increasing public health importance. Globally, children account for a significant proportion of infections. No pathogen-specific treatment currently exists, and the current approach to reducing disease burden is focused on preventative strategies such as vector control, epidemiological interventions, and vaccination in selected populations. Once infected, the mainstay of treatment is supportive, of which appropriate fluid management is a cornerstone. The timely provision of fluid boluses has historically been central to the management of septic shock. However, in patients with dengue shock, particular emphasis is placed on judicious fluid administration. Certain colloids such as hydroxyethyl starches and dextran, despite no longer being used routinely in intensive care units due to concerns of acute kidney injury and impairment of coagulation, are still commonly used in dengue shock syndrome. Current guidelines recommend initial crystalloid therapy, with consideration of colloids for severe or recalcitrant shock in patients with dengue. In this review, we discuss the pathophysiology of septic shock, and consider whether any differences in dengue exist that may warrant a separate approach to fluid therapy. We critically review the available evidence for fluid management in dengue, including the role of colloids. In dengue, there is increasing recognition of the importance of tailoring fluid therapy to phases of disease, with attention to the need for fluid "deresuscitation" once the critical phase of vascular leak passes.
Fulltext Finite element modelling of thermal and moisture mapping of layered cricket helmets

Guan ZW, Dullah AR, Wang XL, Wang QY

Heliyon, 2023 Feb;9(2):e13179.
PMID: 36747568 DOI: 10.1016/j.heliyon.2023.e13179

This paper presents the development of numerical modelling to simulate thermal and moisture mapping of layered cricket helmets. The 3D laser scanning methodology was used to obtain geometrical data of a dummy human head with non-ventilated (NVL) and ventilated (VL) helmets to generate the meshes. Here, heat transfer and mass diffusion were applied in the finite element simulations to model the temperature and relative humidity (RH) distributions inside NVL and VL helmets, which were processed as the temperature-time and RH-time charts. The simulated results were validated against the corresponding experimental measurements with reasonably good correlation, in terms of the general trend on reginal temperature and RH against time, although parameters such as helmet movement and local sweating were not considered in the modelling to simplify the simulation. The discrepancies between the FE simulation results and the measurements are generally within 7% for in-helmet temperature and 5% for RH, for both types of helmets in the low ambient conditions (20 °C and 50% RH), although such the discrepancy is about 10% for the VL helmet subjected to the high ambient conditions (35 °C and 30% RH). The models developed are ready to be used for parametric studies on non-ventilated helmet to optimize the ventilation openings for improving the thermal comfort.
Chikungunya encephalopathy and pneumonia in a young infant presenting with septic shock

Chee YS, Ahamad Fouzi N, Chong YM, Sam IC, Chan YF, Chua CL, et al.

J Paediatr Child Health, 2022 Feb 17.
PMID: 35175651 DOI: 10.1111/jpc.15858
Oral bacteria detection among children with cancer in a tertiary teaching hospital in Kuala Lumpur, Malaysia

Sidi Omar SFN, Ngui R, Ab Rahman SZ, Foo JC, Wang QY, Hassan NA, et al.

Trop Biomed, 2021 Sep 01;38(3):276-282.
PMID: 34362870 DOI: 10.47665/tb.38.3.068

This study sought to determine the prevalence of pathogenic and non-pathogenic bacteria in the oral cavities of children with cancer. There were 68 paediatric patients with cancer who were included in this study. Oral swab samples from the dorsum of tongues and mouth floors of these patients were subjected to culture, staining, and molecular methods to detect the bacteria. The overall prevalence of gram-positive and gram-negative bacteria was 79.4% (54/68; 95% CI = 68.4 - 87.3) and 25% (17/68; 95% CI = 16.2 - 36.4), respectively. Streptococcus salivarius and Streptococcus parasanguinis were the predominant pathogenic grampositive bacteria, while Neisseria subflava and Neisseria perflava were the most common pathogenic gram-negative bacteria. The results revealed that the number of bacteria isolates recovered in patients receiving cancer treatment was higher (55.9%) than those who had not received treatment (16.2%). Therefore, more isolated pathogenic bacteria were observed post-therapy (54.4%). Pathogenic organisms can have significant implications on patient health. Awareness of the types of bacteria inhabiting the oral cavity is essential to predict and prevent dental problems, and their associated systemic complications. Findings on the diversity of oral microflora can also provide a better understanding of the aetiology of oral diseases in paediatric patients receiving cancer treatment.
Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Rosenthal VD, Yin R, Rodrigues C, Myatra SN, Divatia JV, Biswas SK, et al.

Am J Infect Control, 2023 Jul;51(7):751-757.
PMID: 36400318 DOI: 10.1016/j.ajic.2022.11.005

BACKGROUND: Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.
METHODS: We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).
RESULTS: 153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P
Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections

Rosenthal VD, Jin Z, Rodrigues C, Myatra SN, Divatia JV, Biswas SK, et al.

Infect Control Hosp Epidemiol, 2023 Aug;44(8):1261-1266.
PMID: 36278508 DOI: 10.1017/ice.2022.245

OBJECTIVE: To identify risk factors for mortality in intensive care units (ICUs) in Asia.
DESIGN: Prospective cohort study.
SETTING: The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam.
PARTICIPANTS: Patients aged >18 years admitted to ICUs.
RESULTS: In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001).
CONCLUSIONS: Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.
Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries

Rosenthal VD, Yin R, Myatra SN, Divatia JV, Biswas SK, Shrivastava AM, et al.

J Vasc Access, 2024 Mar 27.
PMID: 38539085 DOI: 10.1177/11297298241242163

BACKGROUND: Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly.
METHODS: We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate using the CDC/NSHN definition and criteria. The CLABSI rate per 1000 CL-days was calculated at baseline and throughout different phases of the intervention, including the 2nd month, 3rd month, 4-16 month, and 17-29 month periods. A two-sample t-test was employed to compare baseline CLABSI rates with intervention rates. Additionally, we utilized a generalized linear mixed model with a Poisson distribution to analyze the association between exposure and outcome.
RESULTS: A total of 124,946 patients were hospitalized over 717,270 patient-days, with 238,595 central line (CL)-days recorded. The rates of CLABSI per 1000 CL-days significantly decreased from 16.64 during the baseline period to 6.51 in the 2nd month (RR = 0.39; 95% CI = 0.36-0.42; p