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Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.
Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in the region.
There are four distinct, but closely related, viruses that cause dengue. Recovery from infection by one provides lifelong immunity against that virus but confers only partial and transient protection against subsequent infection by the other three viruses. There is good evidence that sequential infection increases the risk of developing DHF.
The incidence of dengue has grown dramatically around the world in recent decades. Some 2.5 billion people - two fifths of the world's population - are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year.
The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia and the Western Pacific are the most seriously affected. Before 1970 only nine countries had experienced DHF epidemics, a number that had increased more than four-fold by 1995. Not only is the number of cases increasing as the disease is spreading to new areas, but explosive outbreaks are occurring.
According to government figures 15,061 cases of the disease in the Philippines were reported in the first six months of the year. The increase in the number of dengue cases may be attributed to the constantly changing climate brought by global warming as well as congestion in urban areas. The biggest increase in the country was seen in Metro Manila, where there was an almost 200 percent increase.
According to the Department of Health, Southern Mindanao, there is an expected increase in dengue cases in the region because of the onset of the rainy season. About six-percent increase in dengue cases was recorded during the first quarter of the year compared to the same period last year. Davao City still has the highest dengue incidence, with 371 cases recorded in the first quarter. During the same period last year, there were 352 cases recorded in the city.
The durian is the fruit of several tree species belonging to the genus Durio and the Malvaceae family. Widely known and revered in Southeast Asia as the "king of fruits", the durian is distinctive for its large size, unique odour, and formidable thorn-covered husk. The fruit can grow as large as 30Â centimetres (12Â in) long and 15Â centimetres (6Â in) in diameter, and it typically weighs one to threeÂ kilograms (2 to 7Â lb). Its shape ranges from oblong to round, the colour of its husk green to brown, and its flesh pale yellow to red, depending on the species.
There are 30 recognised Durio species, at least nine of which produce edible fruit. Durio zibethinus is the only species available in the international market; other species are sold in their local region.
Studies have shown different uses of durian such as: A.Lipid Lowering Effect: Lipid entrapment property of polysaccharide gel (PG) extracted from fruit-hulls of durian (Durio zibethinus Murr. Cv. Mon-Thong). Results suggest that PG from fruit-hulls of durian may be a potential dietary fiber/ medicinal supplement for a blood lipid / cholesterol lowering effect. B.Hyperthermic Effect / Paracetamol Interaction: Believed to have body-warming properties with concerns on consumption with paracetamol. Rat study showed no significant body temperature elevation. Rats receiving a durian-paracetamol combination showed a significant drop in body temperature. No mechanism for toxicity was identified. C.Antibacterial / Wound Healing Effect: (1) Polysaccharide gel extracted from fruit-hulls of durian seems to have a beneficial effect on wound healing in a pig study.(2) Bactericidal effect of polysaccharide gel was clearly demonstrated against S. aureus and E. coli. Study showed accelerated wound healing. D.Phenolic Content / Antioxidant Effect: Study showed the durian cultivars' high bioactivity and total polyphenols were the main contributors to the overall antioxidant capacity and provides a source of nutritional supplement.
Today, Dengue Fever and Dengue Hemorrhagic Fever affect most Asian countries and has become a leading cause of hospitalization in children (about 500,00 cases each year) and death. Until now, there is no specific treatment on dengue fever. Due to this, a significant number of families of patients use different alternative medicines which do not have evidence for cure in the hope of increasing the platelet count of the patient. One of these is the use of D. zibethinus Murr, but its efficacy is still unkown thus the purpose of the study.
DEFINITION OF TERMS
Dengue Fever - a benign syndrome caused by several arthropod-borne viruses, is characterized by biphasic fever, myalgia or arthralgia, rash, leukopenia, and lymphadenopathy
Dengue Hemorrhagic Fever - a severe, often fatal, febrile disease caused by dengue viruses. It is characterized by capillary permeability, abnormalities of hemostasis, and, in severe cases, a protein-losing shock syndrome (dengue shock syndrome)
Dengue Hemorrhagic Fever Grade I - presence of fever, non-specific constitutional symptoms, such as anorexia, vomiting, abdominal pain; and positive tourniquet test
Dengue Hemorrhagic Fever Grade II - symptoms and signs of Grade I plus spontaneous bleeding: mucocutaneous, gastrointestinal
Dengue Hemorrhagic Fever Grade III - symptoms and signs of Grade II with more severe bleeding plus evidences of circulatory failure: violaceous, cold, clammy skin, restlessness, weak to compressible pulses, narrowing of pulse pressure to 20mmHg or less, or hypotension
Dengue Hemorrhagic Fever Grade IV or Dengue Shock Syndrome - symptoms and signs of Grade III but shock is usually refractory or irreversible and associated with massive bleeding
This study aims to determine the effect of Durio zibethinus Murr (durian) on the platelet count of pediatric patients with Dengue Fever and Dengue Hemorrhagic Fever Grades I and II.
To identify the specific component of durian that is capable of increasing the platelet count of dengue patients.
To determine the mechanism of action of the active component of durian.
To identify significant relationship between the increase of platelet count and intake of durian.
Randomized controlled, double-blinded study
Private Tertiary Hospital
Children ages 6 months old to 18 years old diagnosed with dengue fever and dengue hemorrhagic fever grades I and II.
Parents/guardians of the subjects who signed the informed consent.
Children ages 6 months old to 18 years old diagnosed with dengue hemorrhagic fever III and dengue shock syndrome.
Dengue patients who had undergone blood transfusion.
Dengue patients who do not eat durian or unable to tolerate the smell of durian.
Respondents who developed untoward gastrointestinal side effects during the course of the study, such as nausea, vomiting, diarrhea and dyspepsia.
Parents/guardians who did not sign the informed consent.
Description of Interventions
Patients included in the study will be started with intravenous fluids using Isotonic solutions (D5 LR, D5 NSS/D5 0.9% NaCl) at 3 - 5 cc/kgBW/hr. Patients were then randomly selected to receive durian decoction (experimental group) and evaporated milk (control group). Decoction will be given three times a day from day of diagnosis to day2 afebrile.
Patient's data were collected and recorded. Serial platelet monitoring was done every 6 hours, others were every 8 hours and some on a once a day basis during their hospital stay. Patients are also monitored for possible side effects.
An informed consent has been signed by parents or guardians of the subjects who were included in the study. Socio - demographic data were noted (e.g. age and sex). Clinical data as well as the initial laboratory results were noted. Individuals are randomly selected into two groups, one with the Durian decoction, and the other with evaporated milk. Patient's diagnosed with Dengue fever, Dengue Hemorrhagic Fever Grades I and II will be selected and observed for the duration of hospital stay.
The initial and succeeding platelet count were noted during the introduction of the decoction. Once a day platelet monitoring of all subjects is enough to collect data, provided that it is all taken at the same time. The side effects related to the intake of decoction were all be noted.
Preparation of Decoction:
Scrapings of durian fruit will be obtained thus removing the fruit's seed. __gram of scrapings will be obtained, diluted with __ml of water. __ml of sugar is added to taste. All ingredients is placed in a blender and mixed well to obtain a syrup solution.
Administration of the decoction:
The decoction will be given to patients with platelet count < 150,000 cells/ mm3 during the febrile stage and will be discontinued on the third afebrile stage.