Prolonged dengue outbreak at a high-rise apartment in Petaling Jaya, Selangor, Malaysia: A case study

@#There was an increasing trend in dengue infection in Malaysia with many outbreaks that occurred in Petaling District, Selangor in 2013 – 2014. A high rise apartment in Petaling Jaya reported ten episodes of dengue outbreaks from June 2013 to June 2014. We studied the prolonged dengue hotspot at this residential complex in Petaling Jaya, Selangor and made recommendations to prevent future prolonged dengue outbreaks. This was a retrospective exploratory study by analysing secondary data on dengue outbreaks from years 2013 to 2014. Small group discussions, interview sessions with staff and site visits were carried out to obtain necessary information. Two hundred and ninety-one cases were notified during the dengue outbreaks from Epid week (EW) 25 in 2013 to EW 26 in 2014 with no mortality reported. Information entered into dengue databases might be incomplete or mixed up. Active case detection and environmental risks assessment based on cases were not carry out due to the massive outbreak. Basic information on the population in the outbreak locality was unavailable. Various control activities were carried out with varying outcomes. Community participation was poor with little cooperation from residents during health education and community-based mosquito breeding prevention activities. To ensure better management of dengue outbreaks and to prevent prolonged dengue outbreaks in the future, integrated case findings, effective control activities, extensive environmental assessment on the outbreak locality and adopting innovative community outreach initiative with sufficient staff are required to curb dengue vector.

A study of use of low dose aspirin in prevention of pregnancy induced hypertension.

Forty-six nulliparous women in third trimester of pregnancy with a raised blood pressure of 30 mm Hg (systolic) or/and 15 mm Hg (diastolic) or both, over baseline values were treated with 75 mg of aspirin per day. The results are compared with another 48 age, height, weight, and gestational period matched nulliparaous women with similar condition for trial selection, who were treated as control. There is considerable more number of cases in the control group than in aspirin treated group showing subsequent rise of BP, appearance of proteinuria, and severe pre-eclamptic toxaemia. The aspirin treated group showed increased mean gestational age at termination 39.4 +/- 2.6 weeks as against 38.2 +/- 3.4, increased foetal weight 2860 +/- 552 g as against 2540 +/- 720 g. No case of neonatal haemorrhagic manifestations or congenital malformations were seen. However not much result is obtained with aspirin therapy in cases with established pregnancy induced hypertension or with proteinuria. Hence it is concluded that aspirin therapy should be given to prevent pregnancy induced hypertension. As predictability of other screening tests are not unequivocal, criterion used in this series for screening may be used.

Use of calcium antagonist (nifedipine) in premature labour.

Effectiveness of nifedipine in suppressing premature uterine activity was studied on 20 normal pregnant women who received, depending on the frequency of uterine contractions and degree of cervical dilatation, 5-10 mg nifedipine orally 8 hourly till the uterine contractions were abolished followed by 5 mg 12 hourly up to 38 weeks of gestation. Another 20 age, gravida and gestational period matched normal pregnant women received 10 mg isoxsuprine hydrochloride orally 8 hourly till the uterine contractions were abolished, followed by 10 mg 12 hourly up to 38 weeks of gestation. Successful tocolysis was observed in 85% of cases receiving nifedipine in contrast to 40% of women receiving isoxsuprine hydrochloride. The mean time from presentation to delivery and mean birth weight were 21.8 days and 2510 g respectively in isoxsuprine hydrochloride treated cases and 34.2 days and 2750 g respectively in cases treated with nifedipine. In either group there were no serious untoward effects on mother, labour and baby.