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  • 1

    INSIDE THIS

    ISSUE:

    HOT ISSUE: DENGUE WAR

    1-5

    ANTIMICROBIAL

    RESISTANCE

    6-8

    QUIT SMOKING CLINIC

    9-13

    DRUG COMPARISON: B COMPLEX, NEURO- BION & MECOBALA- MIN IN NERVE RE-

    GENERATION

    14-15

    BYDEUREON 16-18

    QUMC IN PKDMT 19

    TRUTH @ MYTHS:

    STEVIA - A HEALTHY ALTERNATIVE SWEETENER?

    20-22

    PHARMACY BULLETIN

    I S S U E 1 Y E A R 2 0 1 6

    PKD MELAKA TENGAH

    Editorial Board Advisor: Dr. Rusdi bin Abd. Rahman Chief Editor: Mardhiah binti Amir- uddin Editor: Chew Poh Chiong Contributors: Michelle Lim Bee Ping Noorafinah Mohd Zudin Foo Swee Yen Nursyahirah binti Abd Raof

    INTRODUCTION

    Dengue is a mosquito-borne viral disease that has rapidly spread in many regions

    of the world. Dengue is found especially in tropical and subtropical regions of the

    world. The geographical distribution of dengue is linked within the temperature

    range where the mosquito species Aedes that transmits the disease can be found.

    Dengue fever is caused by 4 closely related virus types, which is called serotypes.

    The 4 Dengue Virus (DENV) serotypes are DENV-1, DENV-2, DENV-3 and

    DENV-4.

    DENGUE WAR By : Lee Ai Wei

    EPIDEMIOLOGY

    Epidemiology of dengue worldwide

    The incidence of dengue has grown dramatically around the world in recent dec-

    ades. Up to 3.6 billion people are estimated to now live in tropical and subtropi-

    cal areas where the den-

    gue viruses have the po-

    tential to be transmitted.

    Globally it is estimated

    that approximately 50

    million to 200 million

    deng ue i n f e c t ion s ,

    500,000 cases of severe

    dengue, and over 20,000

    dengue related deaths

    occur annually.

  • 2

    Epidemiology of dengue in Malaysia

    In Malaysia, dengue is predominantly an urban disease due to the abundance of the principle vec-

    tor Aedes aegypti which is at a close proximity to high densities of susceptible hosts. The states of

    Selangor, Wilayah Persekutuan Kuala Lumpur and Johor are the areas that have been largely af-

    fected by the disease and are reporting high numbers of cases.

    TRANSMISSION OF DENGUE

     Spread through a human-to-mosquito-to-human cycle of transmission.

     The two Aedes mosquito species that transmits the disease are Aedes aegypti, which is the

    primary mosquito vector, and Aedes albopictus, which is the secondary mosquito vector.

     When a dengue mosquito bites someone who is sick with dengue fever, that mosquito is

    infected and becomes a carrier of the virus.

     Mosquitoes are capable of spreading the disease within 8-12 days after biting infected person.

     The virus will multiply in the salivary glands of the mosquito and then transferred into a

    healthy human body during mosquito bites.

     Female mosquitoes infected with dengue virus can also transfer the virus to infect its eggs

    next newly hatched mosquito.

     Once the mosquito is infected by the dengue virus, the mosquito is a carrier of the virus for

    life and it can spread the virus to other people by biting them.

     The dengue virus does not spread directly from person to person. Once inside the human

    body, the virus takes 3-14 days to develop before the symptoms of dengue fever.

    HOT ISSUE

  • 3

    Differences between Aedes aegypti and Aedes albopictus

    Aedes aegypti

    Aedes albopictus

    Has bright silvery lyre-shaped dorsal pattern and white banded legs

    Has a single longitudinal silvery dorsal stripe and white banded legs

    Occupies urban areas with or without vege- tation

    Associated with thickets and arboreal vegetation

    Bites, rests, and lays eggs both indoors and outdoors

    Mostly an outdoor (garden) mosquito

    Sneaky biter Aggressive biter

    High preference for taking blood meals from humans and to lesser extent from domestic mammals, which makes it a very capable vector of dengue viruses

    Bites humans but also a variety of available domestic and wild vertebrates that do not carry the dengue viruses, which lowers its capacity to transmit them

    Main dengue vector worldwide Main dengue vector in some areas but is mostly a secondary vector

    The major production places are human- made containers, tree holes and bamboo internodes holding water

    Shows preference for tree holes and bam- boo internodes with water but can also uti- lize human-made containers for its imma- ture development

    SIGNS & SYMPTOMS

    Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of the

    following symptoms:  severe headache

     pain behind the eyes

     muscle and joint pains

     nausea, vomiting

     swollen glands

     rash

    Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after the bite from

    an infected mosquito.

    HOT ISSUE

    MANAGEMENT OF DENGUE

     No specific vaccine or medication to prevent or treat dengue fever currently.

     Treatment is purely concerned with relief of the symptoms (symptomatic).

     Rest and adequate hydration is important.

     Paracetamol can be taken to reduce fever and relieve pain.

     Avoid aspirin in children under the age of 12 years.

     The use of antibiotics is not indicated in dengue infection.

  • 4

    HOT ISSUE CLINICAL COURSE OF DENGUE INFECTION

    After the incubation period, the illness begins abruptly and will be followed by 3 phases.

    Febrile phase

     High grade fever (usually last

    for 2-7 days)

     Accompanied by facial flush-

    ing, rash, generalized body

    ache, vomiting and headache

     Mild haemorrhagic manifesta-

    tions may be seen

     Enlarged and tender liver

     Progressive decrease in

    total white cell count fol-

    lowed by platelet reduction

    Critical phase

     Occurs after third day of fever (may

    occur earlier)

     Lasts about 24- 48 hours

     Rapid drop in temperature

     Patient may deteriorate and manifest

    third space plasma leakage or organ

    dysfunction

     In more severe forms of plasma leakage,

    patient may develop compensated and

    decompensated shock

     Thrombocytopenia and haemoconcen-

    tration are usually detectable in this

    phase

     Leucopenia with relative lymphocytosis,

    clotting abnormalities, elevation of

    transaminases, hypoproteinaemia and

    hypoalbuminaemia are usually observed.

    Recovery phase

     Plasma leakage stops fol-

    lowed by reabsorption of

    extravascular fluid

     Patient’s general well being

    improves

     May have a classical rash of

    “isles of white in the sea of

    red” with generalized

    pruritus

     Haematocrit level stabilises

    and drops further due to

    haemodilution following re-

    absorption of extravascular

    fluid

     Recovery of platelet count is

    preceded by recovery of

    white cell count

    WHO DENGUE CLASSIFICATION

  • 5

    USE OF PAPAYA LEAF EXTRACT IN DENGUE FEVER Papaya leaf extract is now being widely used as a treatment for dengue fever in

    many countries and in some with the approval of their health authorities. Papaya leaf extracts have been

    shown to have many beneficial effects, including reduction in the duration of fever, duration of illness,

    hospital stay, rapid elevation of white blood cells and platelet counts. Randomised controlled trial has

    been done by Institute for Medical Research (IMR) and Tengku Ampuan Rahimah Hospital, results

    showed that there was a significant increase in platelet count among dengue patients administered with

    50gm of fresh papaya leaf juice for three consecutive days.

    Safety concern

    Certain parties stated that papaya leaves contain a dangerous chemical known as cyanogenic glycoside

    which could cause liver, kidney or heart failure and ultimately death. However, content of the deadly

    chemical are very small (0.02 mg in every four leaves). A 60kg person would need to consume 12,000

    papaya leaves at once to cause any acute poisoning. According to Health director-general Datuk Dr

    Noor Hisham Abdullah, papaya leaf juice has been shown to increase blood platelet count and assist in

    the recovery of those with lesser complications, and is unlikely to cause liver, kidney or heart failure.

    HOT ISSUE

    PREVENTION & CONTROL

    OF DENGUE

    Main method is to combat vector

    mosquitoes through:

     Environmental management

    and modification

    (prevent mosquitoes from ac

    cessing egg-laying habitat)

     Improving community partici-

    pation and mobilization for

    sustained vector control;

     Active monitoring and surveil-

    lance of vectors

    REFERENCES 1. Ministry of Health Malaysia. Statistik denggi. Av