Abstract Background: Dengue fever continues to spread worldwide, particularly in tropical regions. Some patients with dengue fever may progress to severe dengue, which is associated with significantly higher morbidity and mortality. Despite this, no definitive treatment has been found to prevent its progression. Montelukast, a leukotriene receptor antagonist, has shown potential in reducing plasma leakage, a key factor in the pathophysiology of severe dengue. Therefore, this study aimed to evaluate the effectiveness of montelukast in reducing the risk of severe dengue. Methods: A systematic literature search was conducted on April 16, 2025, using keywords related to montelukast and dengue across four databases, which included PubMed, Taylor and Francis, Cochrane Library, and ScienceDirect. A critical appraisal was performed using the Oxford Centre for Evidence-Based Medicine framework, evaluating the validity, importance, and applicability of each study. The primary outcomes were the incidence of dengue shock syndrome and dengue with warning signs. The secondary outcomes included mortality rate and hospitalization duration. Results: This study included three studies involving a total of 1057 patients. Montelukast is associated with a reduced incidence of dengue shock syndrome and shorter duration of hospitalization. However, the effect of montelukast on dengue with warning signs and mortality rate was inconclusive. Conclusion: Montelukast shows potential as an adjuvant therapy in preventing the progression of dengue fever to severe dengue. However, further research is required before montelukast can be widely recommended for dengue fever patients in daily clinical practice and possibly integrated into dengue fever clinical guidelines.
evidence-based case report ; severe dengue ; dengue fever ; leukotriene receptor antagonist ; montelukast

Introduction: Severe thyrotoxicosis is an endocrine emergency that may present with multiorgan dysfunction, particularly when precipitated by systemic infection. Management becomes challenging when hepatic injury limits the use of standard antithyroid therapy. We report a case of severe thyrotoxicosis with acute hepatitis in the setting of dengue IgM positivity. Case: A 44-year-old male with chronic alcohol use presented with epistaxis. On examination, he was deeply jaundiced and had tremors on outstretched hands. Initial investigations showed severe hepatitis with AST 2029 U/L, ALT 698 U/L, total bilirubin 236 µmol/L, alkaline phosphatase 138 U/L, and thrombocytopenia (34 ×10⁹/L). Viral hepatitis HBV, HCV, HIV, and autoimmune hepatitis screen were negative. Dengue IgM was positive. Thyroid function tests demonstrated overt thyrotoxicosis with free thyroxine 4 (FT4) 58.6 pmol/L and suppressed thyroid-stimulating hormone. He was managed as severe thyrotoxicosis with impending thyroid crisis in view of systemic illness and multiorgan involvement. Due to significant hepatic dysfunction, he was treated with propranolol, dexamethasone, and lithium carbonate 300 mg BD. Over 5 days, there was marked clinical improvement with resolution of tachycardia and tremors. FT4 decreased to 44.8 pmol/L. Liver function tests improved significantly (AST 157 U/L, ALT 195 U/L, bilirubin 163 µmol/L), and thrombocytopenia resolved (platelets 323 ×10⁹/L). He remained hemodynamically stable with normal Glasgow Coma Scale throughout admission. Conclusion This case highlights severe thyrotoxicosis with acute hepatitis and dengue infection, where management was complicated by contraindication to conventional antithyroid therapy. Lithium and corticosteroids provided effective biochemical and clinical improvement. Early recognition and individualized therapy are crucial in complex multisystem thyrotoxic presentations.
Hepatitis A ; Thyrotoxicosis ; Dengue

Humans ; Dengue/epidemiology* ; Child ; Dengue Virus/isolation & purification* ; China/epidemiology* ; Consensus

Mosquito-borne viruses, including dengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV), pose major threats to public health in tropical and subtropical regions worldwide. Neonates are particularly vulnerable, and the associated disease burden has drawn increasing attention. Routes of neonatal infection include vertical mother-to-child transmission (transplacental and peripartum) and postnatal mosquito bites. Clinical manifestations are often nonspecific; a proportion of cases may progress to central nervous system infection, hemorrhagic disease, or long-term neurodevelopmental impairment, with serious consequences for survival and quality of life. Although China has issued prevention and control guidelines for adults and pregnant women, systematic clinical guidance tailored to neonates remains lacking. In response, the Perinatal Group of the Pediatric Branch of the Chinese Medical Doctor Association convened a multidisciplinary panel to develop this expert consensus, integrating the latest international evidence with China's practical prevention and control experience. The consensus addresses epidemiology; the effects of maternal infection on fetuses and neonates; clinical manifestations; diagnosis and differential diagnosis; early warning indicators of severe disease; therapeutic strategies and supportive care; and prevention and maternal-infant management. It aims to provide evidence-based, standardized, and practical guidance for frontline clinicians managing neonatal mosquito-borne viral infections.
Humans ; Zika Virus Infection/therapy* ; Infant, Newborn ; Chikungunya Fever/therapy* ; Dengue/prevention & control* ; Female ; Pregnancy ; Consensus

OBJECTIVE: To study the results, re-donation situation and characteristics of single-reagent reactive blood donors who were put into the reentry strategy in Wuhan area, explore the rationality and effectiveness of the current reentry strategy, and provide data support for the improvement of the reentry process of blood donors. METHODS: From January 2020 to December 2023, blood donors who conform the reentry criteria and voluntarily applied for returning to Wuhan Blood Center were tested and the results were analyzed. According to the reentry strategy, serological testing and nucleic acid testing were carried out in parallel, serological testing was performed by ELISA with reagents from two different manufacturers, and the primary reactive samples were tested by double-well retest, and HBV/HCV/HIV nucleic acid detection was performed by RT-PCR with an individual donor test mode. Supplementary HBcAb testing was applied for HBV single reagent reactivity by chemiluminescence method. Supplementary TP-WB testing was applied for returning blood donors with repeated TP single reagent reactivity. If returning blood donors with HIV single reagent reactivity were repeated single reagent reactivity, the samples were sent to local CDC for confirmatory test. RESULTS: 7 098 blood donors were qualified for reentry, 716 donors voluntarily applied for reentry, 436 donors successfully reentry, 251 donors entered the next round, 29 donors could not reentry. The reentry rates for the past four years were 66.67%（42/63）, 54.73%（81/148）, 60.71%（136/224） and 62.99%（177/281）, respectively. Up to December 31, 2023, 275 donors donated blood again, and the donation rates for past four years were 76.19%（32/42）, 72.84%（59/81）, 61.76%（84/136） and 56.50%（100/177）, respectively. After donating blood, 31 donors were disqualified again by blood screening and subjected to permanent deferral. The results of returning to the team had statistical differences in reentry items, educational level, age, and marriage（P < 0.05）. CONCLUSION The current reentry strategy adopted by the blood donation and supply institution can effectively retain part of blood donors, reduce the negative emotions of blood donors and increase blood resources.
Humans ; Blood Donors ; China ; Hepatitis B ; Enzyme-Linked Immunosorbent Assay ; Hepatitis C ; Male

OBJECTIVE: To analyze the correlation between the expression levels of Tim-3, C-myc and the proportion of T lymphocyte subsets and prognosis in patients with acute lymphoblastic leukemia (ALL). METHODS: The research group selected 60 ALL patients admitted to our hospital from December 2019 to December 2021, while the control group selected 55 healthy volunteers who underwent physical examination in our hospital. The expression levels of Tim-3, C-myc mRNA and the proportion of T lymphocyte subsets in the two groups were detected. The mortality rate of ALL patients was calculated, and the correlation between the expression levels of Tim-3, C-myc, and the proportion of T lymphocyte subsets and pathological features and prognosis was analyzed. RESULTS: Compared with the control group, the levels of Tim-3, C-myc and CD8⁺ in the research group were increased, while the levels of CD3⁺ , CD4⁺ and CD4⁺ /CD8⁺ were decreased (all P < 0.001). The levels of Tim-3, C-myc mRNA, CD3⁺ , CD4⁺ , CD8⁺ , CD4⁺ /CD8⁺ were correlated with risk classification and extramedullary infiltration (all P < 0.05). The survival rate of patients with low expression of Tim-3, C-myc, and CD8⁺ was higher than that of patients with high expression, while the survival rate of patients with high expression of CD3⁺ , CD4⁺ , and CD4⁺ /CD8⁺ was higher than that of patients with low expression (all P < 0.05). Univariate analysis showed that the deceased patients had higher proportions of extramedullary infiltration and high-risk classification, as well as higher levels of Tim-3, C-myc, and CD8⁺ , while lower levels of CD3⁺ , CD4⁺ , and CD4⁺ /CD8⁺ compared with surviving patients (all P < 0.01). Multivariate logistic regression analysis showed that extramedullary invasion, risk classification, Tim-3, C-myc, CD3⁺ , CD4⁺ , CD8⁺ , CD4⁺ /CD8⁺ were the main factors affecting the prognosis of ALL patients (all P < 0.05). ROC curve analysis showed that the combination of Tim-3, C-myc, and T lymphocyte subsets had higher sensitivity and accuracy in predicting prognosis of ALL patients compared with the single diagnosis of Tim-3, C-myc, CD3⁺ , CD4⁺ , CD8⁺ , and CD4⁺ /CD8⁺ (P < 0.05). CONCLUSION ALL patients show higher levels of Tim-3, C-myc mRNA and CD8⁺ but lower levels of CD3⁺ , CD4⁺ and CD4⁺/CD8⁺. Moreover, the expression levels of Tim-3, C-myc, CD3⁺ , CD4⁺ , CD8⁺ and CD4⁺/CD8⁺ are correlated with extramedullary invasion, high-risk classification and prognosis.
Humans ; Hepatitis A Virus Cellular Receptor 2/metabolism* ; Prognosis ; Proto-Oncogene Proteins c-myc/metabolism* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis* ; T-Lymphocyte Subsets ; Male ; Female ; Adult ; Middle Aged ; Adolescent ; RNA, Messenger

OBJECTIVE

Dengue remains a critical public health concern in the Philippines. Late consultation and delayed presentation of dengue patients to hospitals constantly challenge doctors. This study aimed to identify factors contributing to late consultation of dengue patients.

This analytic, cross-sectional study examined patient, parental, socioeconomic, cultural, and health system factors influencing delayed consultation among parents of patients 0 – 18 years at Batangas Medical Center and Lipa Medix Medical Center. A total of 668 parents were enrolled. Descriptive statistics and frequency tables summarized the key characteristics. Test of proportions assessed differences between groups. Univariate logistic regression screened possible predictors, followed by multiple logistic regression to identify significant factors.

Univariate analysis identified significant predictors of late consultation, including older patient age(p=0.002), residence >50 km from the hospital (p 50 km from the hospital were 2.7 times more likely to consult late (p=0.01).

Delayed consultation was influenced by the patient age, hospital type, geographic distance from the hospital, maternal marital status, and cultural beliefs in home remedies and faith healing. Strategies to improve early consultation should consider these factors.

OBJECTIVE

To determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the first three days of dengue illness are independent predictors of dengue severity among pediatric patients.

A cross-sectional analytical retrospective study was conducted among pediatric dengue patients admitted to The Medical City, Pasig from September 2021 to August 2024. Data collection was done through electronic chart review. Baseline characteristics were analyzed using the Kruskal-Wallis test, Chi-Square test, and Fisher’s exact test. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses, along with diagnostic performance metrics, were used to evaluate daily ratio cut-offs differentiating dengue classifications. Multivariable logistic regression was performed to assess NLR and PLR as independent predictors of warning signs or severe dengue development.

Among the 316 subjects included in the analysis, 40.5% had dengue fever without warning signs, 57.3% had dengue fever with warning signs, and 2.2% had severe dengue. Differentiating patients without warning signs from those with warning signs, the NLR cut-offs were 4.73, 2.07, and 2.5 on days 1-3, respectively, whereas from those with severe dengue, the cut-offs were 1.27, 0.68, and 0.47 on the same days. For this pairwise analysis, PLR cut-offs were 170, 233.92, and 208.79 for the first comparison; and 209.24, 244.12, and 187.5 for the second, respectively. Statistical analysis showed poor discrimination and diagnostic performance for all cut-offs. Likewise, multivariable linear regression revealed no significant correlation between either ratio and dengue severity.

NLR and PLR within the first three days of dengue illness revealed poor performance in predicting the development of warning signs or progression to severe dengue among pediatric patients.

OBJECTIVE

To describe a case of dengue-associated bilateral neuroretinitis in a young female adult.

This is a case report.

A 25-year-old female was referred for evaluation of bilateral blurring of vision during the convalescent stage of dengue fever. Visual acuity was 20/80 in each eye. Fundoscopy showed mild optic disc swelling, macular thickening, and hard exudates bilaterally. Dengue-associated neuroretinitis was considered. Intravenous methylprednisolone treatment for three days resulted in significant improvements in visual function and resolution of fundus abnormalities.

Dengue is a potential etiology of neuroretinitis in endemic areas, especially in those who develop visual symptoms during the convalescent phase. Prompt recognition and treatment may prevent long-term visual impairment.

Correctional facilities are a major hub of hepatitis C virus (HCV), with rates far higher than those observed in the general population. Once considered an intractable crisis, the current situation offers a unique opportunity. The advent of direct-acting antivirals has changed the HCV treatment landscape, making its elimination possible. This review summarises the scientific evidence and progress towards HCV elimination in correctional health systems. It outlines the evolution of 'test-and-treat' models, assesses micro-elimination success worldwide, especially in Singapore, and highlights collaborative efforts between Changi General Hospital and Singapore Prison Services. Their implementation of HCV treatment guidelines serves as a key case study in this context. This review also analyses the various barriers - structural, financial, clinical and logistical - that hinder progress. It consolidates strong evidence that prison-based HCV treatment is cost-effective, promotes health equity, supports the World Health Organization 2030 goals and reduces the societal burden of HCV.
Humans ; Singapore ; Antiviral Agents/therapeutic use* ; Hepatitis C, Chronic/epidemiology* ; Prisons ; Prisoners ; Disease Eradication ; Cost-Benefit Analysis ; Hepacivirus ; Correctional Facilities