Insights into the Role of Biopolymer Aerogel Scaffolds in Tissue Engineering and Regenerative Medicine.

The global transplantation market size was valued at USD 8.4 billion in 2020 and is expected to grow at a compound annual growth rate of 11.5% over the forecast period. The increasing demand for tissue transplantation has inspired researchers to find alternative approaches for making artificial tissues and organs function. The unique physicochemical and biological properties of biopolymers and the attractive structural characteristics of aerogels such as extremely high porosity, ultra low-density, and high surface area make combining these materials of great interest in tissue scaffolding and regenerative medicine applications. Numerous biopolymer aerogel scaffolds have been used to regenerate skin, cartilage, bone, and even heart valves and blood vessels by growing desired cells together with the growth factor in tissue engineering scaffolds. This review focuses on the principle of tissue engineering and regenerative medicine and the role of biopolymer aerogel scaffolds in this field, going through the properties and the desirable characteristics of biopolymers and biopolymer tissue scaffolds in tissue engineering applications. The recent advances of using biopolymer aerogel scaffolds in the regeneration of skin, cartilage, bone, and heart valves are also discussed in the present review. Finally, we highlight the main challenges of biopolymer-based scaffolds and the prospects of using these materials in regenerative medicine.

The Role of Biopolymer-Based Materials in Obstetrics and Gynecology Applications: A Review.

Biopolymers have gained tremendous attention in many daily life applications, including medical applications, in the past few years. Obstetrics and gynecology are two fields dealing with sensitive parts of the woman's body and her newborn baby, which are normally associated with many issues such as toxicity, infections, and even gene alterations. Medical professions that use screening, examination, pre, and post-operation materials should benefit from a better understanding of each type of material's characteristics, health, and even environmental effects. The underlying principles of biopolymer-based materials for different obstetric and gynecologic applications may discover various advantages and benefits of using such materials. This review presents the health impact of conventional polymer-based materials on pregnant women's health and highlights the potential use of biopolymers as a safer option. The recent works on utilizing different biopolymer-based materials in obstetric and gynecologic are presented in this review, which includes suture materials in obstetric and gynecologic surgeries, cosmetic and personal care products, vaginal health, and drug delivery; as well as a wound dressing and healing materials. This review highlights the main issues and challenges of biopolymers in obstetric and gynecologic applications.

Foetal and maternal outcomes in hyperuricaemia pre-eclampsia patients in Hospital Universiti Sains Malaysia.

Preeclampsia patients have frequently been found to experience hyperuricaemia and this may result in poor outcomes compared to those with normal uric acid levels. This study aimed to determine the relationship of hyperuricaemia in pre-eclampsia patients with foetal and maternal outcomes. This prospective cohort study involved 79 patients in a tertiary centre from year 2016 to 2018. Blood samples were taken antenatally and at the 6th week, post-delivery for renal function including serum uric acid level. Our findings indicate that there was a higher incidence of poor maternal and foetal outcomes in the hyperuricaemia group than the normal uric acid group. Serum uric acid has been shown to be a significant predictor for low birth weight and premature delivery in preeclampsia patients. It was also found that there was a significant negative correlation between uric acid level and antenatal creatinine clearance (rs = -0.338, p = .002). The assessment of the serum uric acid level seems to be important to ensure better outcomes in patients with preeclampsia.Impact statementWhat is already known on this subject? Preeclampsia is a serious pregnancy-related complication and remains as one of the most important cause of maternal and foetal morbidity and mortality, affecting 2-8% in all pregnancy. Many studies have established the association between hyperuricaemia and preeclampsia. Besides, numerous studies have found that hyperuricaemia contributed to adverse maternal and foetal outcomes.What the results of this study add? There was a significant increase in adverse foetal and maternal outcomes in the hyperuricaemia group compared to the normal uric acid group. This study revealed that serum uric acid remains a significant predictor for low birth weight and premature delivery in preeclampsia patients.What the implications are of these findings for clinical practice and/or further research? Hyperuricaemia does not merely become an indicator for the severity of disease in preeclampsia patients but also indicates adverse foetal outcomes. Large population-based studies are required to establish the absolute maternal and foetal outcomes in patients with hyperuricaemia. Besides, further studies are recommended on long-term implication of hyperuricaemia which is not limited to only during antenatal period.

A Review on Revolutionary Natural Biopolymer-Based Aerogels for Antibacterial Delivery.

A biopolymer-based aerogel has been developed to become one of the most potentially utilized materials in different biomedical applications. The biopolymer-based aerogel has unique physical, chemical, and mechanical properties and these properties are used in tissue engineering, biosensing, diagnostic, medical implant and drug delivery applications. Biocompatible and non-toxic biopolymers such as chitosan, cellulose and alginates have been used to deliver antibiotics, plants extract, essential oils and metallic nanoparticles. Antibacterial aerogels have been used in superficial and chronic wound healing as dressing sheets. This review critically analyses the utilization of biopolymer-based aerogels in antibacterial delivery. The analysis shows the relationship between their properties and their applications in the wound healing process. Furthermore, highlights of the potentials, challenges and proposition of the application of biopolymer-based aerogels is explored.

A Review on Micro- to Nanocellulose Biopolymer Scaffold Forming for Tissue Engineering Applications.

Biopolymers have been used as a replacement material for synthetic polymers in scaffold forming due to its biocompatibility and nontoxic properties. Production of scaffold for tissue repair is a major part of tissue engineering. Tissue engineering techniques for scaffold forming with cellulose-based material is at the forefront of present-day research. Micro- and nanocellulose-based materials are at the forefront of scientific development in the areas of biomedical engineering. Cellulose in scaffold forming has attracted a lot of attention because of its availability and toxicity properties. The discovery of nanocellulose has further improved the usability of cellulose as a reinforcement in biopolymers intended for scaffold fabrication. Its unique physical, chemical, mechanical, and biological properties offer some important advantages over synthetic polymer materials. This review presents a critical overview of micro- and nanoscale cellulose-based materials used for scaffold preparation. It also analyses the relationship between the method of fabrication and properties of the fabricated scaffold. The review concludes with future potential research on cellulose micro- and nano-based scaffolds. The review provides an up-to-date summary of the status and future prospective applications of micro- and nanocellulose-based scaffolds for tissue engineering.

5-Year review on amniocentesis and its maternal fetal complications.

Background Amniocentesis is a well-known invasive procedure which is commonly carried out in the second trimester. The indication for amniocentesis varies throughout countries and centers. Despite providing significant prenatal diagnosis; many maternal and fetal complications have been reported from previous studies. Materials and methods This retrospective study aimed to determine the maternal and fetal complications following amniocentesis. This study involved all patients who underwent amniocentesis from January 2012 until June 2017 in a tertiary centre. Maternal age, parity, premorbid medical conditions, amniocentesis indications, gestational age during amniocentesis, karyotyping results, complications during and post procedure and the fetal outcomes were reviewed and analyzed. Results One hundred and fourteen patients' medical records were reviewed and the majority of patients (50.9%) ranged in age from age 30 to 39 years old with mean age of 34.29 years. Amniocentesis was performed during the second trimester in the majority of patients (71.1%). The indications for amniocentesis in this study were polyhydramnios (7.9%), advanced maternal age (9.6%), risk of Down's syndrome (31.6%), increased risk of Patau syndrome (6.1%), increased risk of Edward's syndrome (4.4%) and abnormal fetal ultrasonography (70.2%). Cytogenetics results of amniocentesis were normal in 82 patients (71.9%). The majority of patients (86.0%) had no complications. Two patients (12.5%) had intrauterine death presumed to be procedural related. Conclusion This 5-year retrospective study on amniocentesis procedure showed that the majority of amniocentesis were safe as 86.0% of the patients were free from any complications. Anticipating its complication is important as there is always a risk even though it is a safe procedure in general.

Human albumin infusion for treating oedema in people with nephrotic syndrome.

BACKGROUND: Oedema is a common clinical symptom in people with nephrotic syndrome and human albumin has been widely used in the treatment of oedema by increasing vascular volume and this inducing diuresis. It may be used with or without diuretics such as furosemide. However, the quantitative contribution of human albumin in treating oedema is not fully understood. If human albumin were found to be effective and safe in the treatment of oedema, it could help clinicians to develop therapeutic strategies to improve the management of diuretic resistance associated with nephrotic syndrome. OBJECTIVES: This review aimed to examine the benefits and harms of human albumin infusion for treating oedema associated with nephrotic syndrome. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 23 June 2019 through contact with the Information Specialists using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effect of human albumin infusion compared with placebo or no intervention, human albumin with diuretics compared with diuretic alone, human albumin compared with diuretics and other treatments, clinical outcomes, death, quality of life, kidney function and adverse effects in people with nephrotic syndrome. We excluded cross-over studies but data for the first period was to be included if available. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration were used. Two authors independently assessed eligibility, risk of bias, study quality and extracted data. We calculated mean difference (MD) for continuous data with 95% confidence intervals (CI). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: One study met our inclusion criteria (26 children with minimal change nephrotic syndrome) and 11 were excluded (nine cross-over studies, one where albumin was not used for nephrotic syndrome and one where authors did not state whether the children had oedema). Risk of bias for the included study was unclear for selection bias, high for performance and detection bias, low for attrition bias, and high for selective reporting. The included study compared albumin plus furosemide with an equal volume of dextrose. Of our prespecified outcomes, the authors reported clinical improvement as weight change, serum sodium and adverse outcomes (blood pressure). The authors reported a greater weight loss in the albumin treated group initially but no difference overall at 10 days. However, the data in the text and the figures were inconsistent so we could not confirm the authors statements (very low certainty evidence). It is uncertain whether albumin infusion improves serum sodium when compared with an equal volume of dextrose (MD 2.00 mEq/L, 95% CI -0.09 to 4.09), systolic blood pressure (MD 2.00 mmHg, 95% CI -3.52 to 7.52) or diastolic blood pressure (MD 2.00 mmHg, 95%CI -4.29 to 8.29). Death, quality of life, and kidney function were not reported. AUTHORS' CONCLUSIONS: We identified only one small study that was relevant to our review, therefore we are unable to draw any conclusions regarding the use of human albumin with or without diuretics in nephrotic syndrome. More RCTs are needed.

Progression and outcomes of non-dialysis dependent chronic kidney disease patients: A single center longitudinal follow-up study.

AIM: Despite increase global prevalence of End stage renal disease (ESRD) and subsequent need for renal replacement therapy (RRT), relatively little is known about disease progression and prognosis of earlier stages of CKD. Current study was conducted to examine rate of CKD progression, predictors of ESRD and death. METHODS: A total 621 patients with estimated glomerular filtration rate (eGFR) of 15-59ml/min/1.73m2 (CKD stage 3 & 4) were selected and followed up for 10 years or until ESRD or death, whichever occurred first. Subjects who did not meet inclusion criteria were excluded (n=1474). RESULTS: Annual cumulative decline in eGFR was 3.01±0.40 ml/min/1.73m2 . Overall disease progression was observed in 60% patients while 18% died. Among patients with CKD stage 3, 21% progressed to stage 4, 10% to stage 5ND (non-dialysis) and 31% to RRT while mortality was observed in 16% patients. On the other hand, 8% patients with CKD stage 4 progressed to stage 5ND, 31% to RRT and mortality was observed in 24% cases. Patients with CVD, higher systolic blood pressure, elevated phosphate levels, heavy proteinuria, microscopic hematuria and use of diuretics were more likely to develop ESRD. Advancing age, low eGFR, low systolic blood pressure, low hemoglobin and baseline diabetes were found to be significant predictors of mortality while being female reduced risk of mortality. CONCLUSION: Our data suggest that, in this CKD cohort, patients were more likely to develop ESRD than death. Prime importance should be given to mild forms of CKD to retard and even reverse CKD progression.

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study.

OBJECTIVE:: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. METHOD:: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. RESULTS:: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. CONCLUSION:: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study / Anemia em pacientes pré-diálise: prevalência, gravidade, manejo

Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

Resumo Objetivo: anemia é uma complicação comum de doenças renais crônicas (DRC) e está significativamente envolvida na morbidade cardiovascular. O objetivo de nosso estudo foi investigar a prevalência e a gravidade da anemia em pacientes adultos pré-diálise, bem como determinar fatores preditores da terapia antianêmica. Método: estudo retrospectivo observacional foi realizado em pacientes pré-diálise adultos que recebiam tratamento no Hospital Universiti Sains Malaysia de janeiro de 2009 a dezembro de 2013. Resultados: ao todo, 615 casos elegíveis foram incluídos. A idade média dos pacientes foi de 64,1±12,0 anos. A prevalência de anemia foi de 75,8%, e a gravidade da anemia foi considerada leve em 47,7%, moderada em 32,2% e grave em 20% dos pacientes. Com base nas características morfológicas da anemia, os pacientes foram classificados em anemia normocrômica normocítica (76,9%), anemia hipocrômica microcítica (21,8%) e anemia macrocítica (1,3%). Suplementos de ferro oral foram prescritos para 38% dos pacientes e a nenhum dos pacientes foram dados eritropoietina, agentes estabilizadores (ESA) e preparações de ferro por via intravenosa. Na regressão logística, os preditores significativos de utilização da preparação antianêmica foram diminuição da hemoglobina e do hematócrito e estágios avançados da DRC. Conclusão: os resultados do presente estudo sugerem que a prevalência de anemia em pacientes pré-diálise é maior do que o atualmente aceito e está associado com a função renal; a prevalência aumenta com a diminuição da função renal. A identificação precoce e o manejo adequado da anemia não só terão um impacto positivo na qualidade de vida, mas também reduzirão internações de pacientes com DRC decorrentes de eventos cardiovasculares.

Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis.

BACKGROUND: Several criteria have been used to stratify acute kidney injury (AKI) in dengue infection and have resulted in variations in its incidence as well as clinic-laboratory characteristics. The current study was aimed to compare three commonly used criteria of AKI among patients with dengue. METHODS: 667 patients with dengue were defined and staged according to the conventional definition (CD), the Acute Kidney Injury Network (AKIN) and the Risk, Injury, Failure, Loss of function, End stage renal disease (RIFLE) criteria. Appropriate statistical methods were used to compare these three criteria. RESULTS: The incidence of AKI during dengue infection was 14.2% by AKIN criteria, 12.6% by RIFLE criteria and 4.2% by CD. AKIN and RIFLE criteria were comparable while AKIN-I identified 11 more patients with AKI than RIFLE-R (76.8% vs. 73.8%, p=0.023). CD was found to be less sensitive than AKIN and RIFLE due to stratification of only severe AKI cases with serum creatinine ≥176.8 µmol/L. Overall mortality was 1.2% and severe stages of AKI were associated with increased mortality (p<0.001). AKIN criteria identified seven risk factors, RIFLE identified six and CD identified three risk factors. Old age, severe dengue and the use of nephrotoxic drugs were found to be independent predictors identified by all criteria while hypertension was only identified by AKIN. CONCLUSIONS: The incidence of AKI in dengue infection, the risk factors for its development and clinico-laboratory characteristics vary significantly according to the diagnostic criteria used. In our analysis, AKIN and RIFLE were comparable to each other and superior to CD with regard to early diagnosis and sensitivity.

Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula / Causas imputáveis da doença renal crônica em adultos: um estudo retrospectivo de cinco anos de um Hospital de Assistência Terciária no nordeste do Península da Malásia

ABSTRACT CONTEXT AND OBJECTIVE: Chronic kidney disease (CKD) is an escalating medical and socioeconomic problem worldwide. Information concerning the causes of CKD, which is a prerequisite for reducing the disease burden, is sparse in Malaysia. Therefore, this study aimed to evaluate the attributable causes of CKD in an adult population at a tertiary referral hospital. DESIGN AND SETTING: Retrospective study at Hospital Universiti Sains Malaysia (HUSM). METHODS: This was an analysis based on medical records of adult patients at HUSM. Data regarding demographics, laboratory investigations, attributable causes and CKD stage were gathered. RESULTS: A total of 851 eligible cases were included. The patients' mean age was 61.18 ± 13.37 years. CKD stage V was found in 333 cases (39.1%) whereas stages IV, IIIb, IIIa, and II were seen in 240 (28.2%), 186 (21.9%), 74 (8.7%) and 18 (2.1%), respectively. The percentage of CKD stage V patients receiving renal replacement therapy was 15.6%. The foremost attributable causes of CKD were diabetic nephropathy (DN) (44.9%), hypertension (HPT) (24.2%) and obstructive uropathy (9.2%). The difference in the prevalence of CKD due to DN, HPT and glomerulonephritis between patients ≤ 50 and > 50 years old was statistically significant. CONCLUSION: Our results suggest that DN and HPT are the major attributable causes of CKD among patients at a Malaysian tertiary-care hospital. Furthermore, the results draw attention to the possibility that greater emphasis on primary prevention of diabetes and hypertension will have a great impact on reduction of hospital admissions due to CKD in Malaysia.

RESUMO CONTEXTO E OBJETIVO: Doença renal crônica (DRC) é um problema médico e socioeconômico crescente. As informações relativas às causas da DRC são pré-requisito para reduzir a carga da doença, e são escassas na Malásia. Este estudo tem como objetivo avaliar as causas atribuíveis à DRC na população adulta de um hospital de referência terciária. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Hospital Universiti Sains Malaysia (HUSM). MÉTODOS: Análise de prontuários de pacientes adultos de HUSM. Foram obtidos dados demográficos, exames laboratoriais, causas atribuíveis e estágio da DRC. RESULTADOS: Um total de 851 casos elegíveis foi incluído. A idade média dos pacientes foi de 61,18 ± 13,37 anos. DRC fase V foi contabilizada em 333 casos (39,1%), enquanto casos de estágio IV, IIIb, IIIa e II foram 240 (28,2%), 186 (21,9%), 74 (8,7%) e 18 (2,1%), respectivamente. A porcentagem de pacientes com DRC estágio V recebendo a terapia de substituição renal foi 15,6%. As causas atribuíveis mais importantes da DRC foram nefropatia diabética (ND) (44,9%), hipertensão (24,2%) e uropatia obstrutiva (9,2%). A diferença na prevalência da DRC devido à ND, hipertensão e glomerulonefrite entre pacientes ≤ 50 anos e > 50 anos de idade foi estatisticamente significativa. CONCLUSÃO: Nossos resultados sugerem que a ND e a hipertensão são as principais causas atribuíveis da DRC em pacientes sob cuidados terciários na Malásia. Os resultados apontam para a possibilidade de maior ênfase na prevenção primária da diabetes e hipertensão como impactante na redução das internações hospitalares devidas a DRC na Malásia.

Dengue-induced Acute Kidney Injury (DAKI): A Neglected and Fatal Complication of Dengue Viral Infection--A Systematic Review.

Dengue Viral Infection (DVI) imperils an estimated 2.5 billion people living in tropical and subtropical regions. World Health Organization (2011) guidelines also classified dengue as 'Expanded Dengue Syndrome' to incorporate wide spectrum of unusual manifestations of dengue infection affecting various organ systems - including liver, kidney, heart and brain. Renal involvements are least appreciated area of dengue infection, therefore, we systematically reviewed studies describing renal disorders in dengue infection, with emphasis on Acute Kidney Injury (AKI). The purpose of current review is to underscore clinicians’attention to this neglected intricacy of DVI. It suggests that dengue induced renal involvements vary from glomerulonephritis, nephrotic range proteinuria and AKI. We observed great disparity in incidence of AKI among dengue patients, based upon criteria used to define AKI. AKI among dengue patients was found to be associated with significant morbidity, mortality and longer hospitalization, adding financial burden to patients and healthcare system. Additionally, we identified several predictors of AKI in dengue patients including old age, obesity, severe dengue infection and concurrent bacterial or viral infection. Direct viral injury and deposition of antigen-antibody complex in glomerulus were found to be possible causes of renal disorders in dengue infection. Prior knowledge of clinico-laboratory characteristics and risk factors with early detection of AKI by using appropriate criteria would not only reduce morbidity and mortality but also decrease burden to patients and healthcare system.

Clinico-laboratory spectrum of dengue viral infection and risk factors associated with dengue hemorrhagic fever: a retrospective study.

BACKGROUND: The incidence of dengue is rising steadily in Malaysia since the first major outbreak in 1973. Despite aggressive measures taken by the relevant authorities, Malaysia is still facing worsening dengue crisis over the past few years. There is an urgent need to evaluate dengue cases for better understanding of clinic-laboratory spectrum in order to combat this disease. METHODS: A retrospective analysis of dengue patients admitted to a tertiary care teaching hospital during the period of six years (2008 - 2013) was performed. Patient's demographics, clinical and laboratory findings were recorded via structured data collection form. Patients were categorized into dengue fever (DF) and dengue hemorrhagic fever (DHF). Appropriate statistical methods were used to compare these two groups in order to determine difference in clinico-laboratory characteristics and to identify independent risk factors of DHF. RESULTS: A total 667 dengue patients (30.69 ± 16.13 years; Male: 56.7 %) were reviewed. Typical manifestations of dengue like fever, myalgia, arthralgia, headache, vomiting, abdominal pain and skin rash were observed in more than 40 % patients. DHF was observed in 79 (11.8 %) cases. Skin rash, dehydration, shortness of breath, pleural effusion and thick gall bladder were more significantly (P < 0.05) associated with DHF than DF. Multivariate regression analysis demonstrated presence of age > 40 years (OR: 4.1, P < 0.001), secondary infection (OR: 2.7, P = 0.042), diabetes mellitus (OR: 2.8, P = 0.041), lethargy (OR: 3.1, P = 0.005), thick gallbladder (OR: 1.7, P = 0.029) and delayed hospitalization (OR: 2.3, P = 0.037) as independent predictors of DHF. Overall mortality was 1.2 % in our study. CONCLUSIONS: Current study demonstrated that DF and DHF present significantly different clinico-laboratory profile. Older age, secondary infection, diabetes mellitus, lethargy, thick gallbladder and delayed hospitalization significantly predict DHF. Prior knowledge of expected clinical profile and predictors of DHF/DSS development would provide information to identify individuals at higher risk and on the other hand, give sufficient time to clinicians for reducing dengue related morbidity and mortality.

Incidence, Characteristics and Risk Factors of Acute Kidney Injury among Dengue Patients: A Retrospective Analysis.

BACKGROUND: Dengue induced acute kidney injury (AKI) imposes heavy burden of illness in terms of morbidity and mortality. A retrospective study was conducted to investigate incidence, characteristics, risk factors and clinical outcomes of AKI among dengue patients. METHODOLOGY: A total 667 dengue patients (2008-2013) were retrospectively evaluated and were stratified into AKI and non-AKI groups by using AKIN criteria. Two groups were compared by using appropriate statistical methods. RESULTS: There were 95 patients (14.2%) who had AKI, with AKIN-I, AKIN-II and AKIN-III in 76.8%, 16.8% and 6.4% patients, respectively. Significant differences (P<0.05) in demographics and clinico-laboratory characteristics were observed between patients with and without AKI. Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64­17.59), P<0.001],rhabdomyolysis [OR (95% CI): 7.9 (3.04­20.49)], multiple organ dysfunction OR (95% CI):17.9 (9.14­35.12), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12­19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12­19.86), P = 0.033] and use of nephrotoxic drugs [OR(95% CI): 2.9 (1.12­19.86), P = 0.006] were associated with AKI. Longer hospital stay (>3days) was also observed among AKI patients (OR = 1.3, P = 0.044) [corrected].Additionally, 48.4% AKI patients had renal insufficiencies at discharge that were signicantly associated with severe dengue, secondary infection and diabetes mellitus. Overall mortality was 1.2% and all fatal cases had AKI. CONCLUSIONS: The incidence of AKI is high at 14.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stay and poor renal outcomes. Our findings suggest that AKI in dengue is likely to increase healthcare burden that underscores the need of clinicians' alertness to this highly morbid and potentially fatal complication for optimal prevention and management.

Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula.

CONTEXT AND OBJECTIVE: Chronic kidney disease (CKD) is an escalating medical and socioeconomic problem worldwide. Information concerning the causes of CKD, which is a prerequisite for reducing the disease burden, is sparse in Malaysia. Therefore, this study aimed to evaluate the attributable causes of CKD in an adult population at a tertiary referral hospital. DESIGN AND SETTING: Retrospective study at Hospital Universiti Sains Malaysia (HUSM). METHODS: This was an analysis based on medical records of adult patients at HUSM. Data regarding demographics, laboratory investigations, attributable causes and CKD stage were gathered. RESULTS: A total of 851 eligible cases were included. The patients' mean age was 61.18 ± 13.37 years. CKD stage V was found in 333 cases (39.1%) whereas stages IV, IIIb, IIIa, and II were seen in 240 (28.2%), 186 (21.9%), 74 (8.7%) and 18 (2.1%), respectively. The percentage of CKD stage V patients receiving renal replacement therapy was 15.6%. The foremost attributable causes of CKD were diabetic nephropathy (DN) (44.9%), hypertension (HPT) (24.2%) and obstructive uropathy (9.2%). The difference in the prevalence of CKD due to DN, HPT and glomerulonephritis between patients ≤ 50 and > 50 years old was statistically significant. CONCLUSION: Our results suggest that DN and HPT are the major attributable causes of CKD among patients at a Malaysian tertiary-care hospital. Furthermore, the results draw attention to the possibility that greater emphasis on primary prevention of diabetes and hypertension will have a great impact on reduction of hospital admissions due to CKD in Malaysia.