Irfan Mohamad (Otorhinolaryngology) Wan Yus Haniff (Internal Medicine) Rosline Hassan (Hematology)

1. “The Effect of Mangrove Crab Soup on Improvement of Clinical Symptoms and Platelet Level in Dengue Patient-A Pilot Study” Irfan Mohamad (Otorhinolaryngology) Wan Yus Haniff (Internal Medicine) Rosline Hassan (Hematology) Nutritionist / Dietitian Pharmacology / Biology

3. Malaysia • In 2007, 48,185 dengue cases were reported, with 98 deaths • In 2008, during the 1st week, 734 cases including 3 deaths were reported In the 37th week (7-13 September 2008), 837 cases reported (with 3 deaths) • Source : Disease Control Division, Ministry of Health Malaysia, epid Week 1& 37, 2008

4. Globally… • More than 500,000 people — mostly children and infants — contract this more severe form of dengue, which kills 20,000 every year, making it a leading cause of childhood death in many countries. And the numbers are increasing. • Dengue fever climbs the social ladder. Nature 448, 734 - 735 (2007) . doi:10.1038/448734a

5. Actions by Ministry of Health include : • Compound • Aerosol spray/fogging • Notification • Health Education

6. Treatment is mainly supportive • Hydration • Platelet monitoring • Transfusion • Antipyretics • Many still under trials

7. Promising? • Several vaccine developers have utilized live-attenuated live tetravalent vaccines and two of them have already completed phase two trials. However, the risk of antibody-dependent enhancement infection is not well elucidated. • Morita K. Dengue vaccines. Nippon Rinsho. 2008 Oct;66(10):1999-2003.

8. Strains of each of the 4 DV serotypes, attenuated by passage in tissue culture or by recombinant DNA technology, have been formulated into tetravalent vaccines and have entered successful phase 1 and 2 clinical trials in the United States and Southeast Asia.

9. For the first time in 60 years, the pipeline of dengue vaccines looks promising. • A protective tetravalent vaccine must be licensed soon if dengue is to be brought under control. • Edelmen R. Dengue vaccines approach the finish line. Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S56-60.

10. Why using crab? No published data to show the effect of taking crab meat on any disease Nutritive value of crabs described Old generation people believe that taking crab meat soup is very helpful in treating some illnesses including dengue

11. Nutritive value • The crab showed higher protein content (78.50%) when compared to the mussel (63.75%) and the oyster (40.14%). • As to wet weight basis, the lipid contents were quite low ranging from 0.25 to 1.19%.

12. Carbohydrate content ranged from 2.26 % (crab) to 4.60% (mussel). • These shellfishes represent a good source of minerals satisfying from 7.6 to 100% the highest requirements suggested by The Food and Nutrition Board, Institute of Medicine (2002).

13. Caravalho AF, Farias DF, Barroso CX et al.Nutritive value of three organisms from mangrove ecosystem: Ucides cordatus (Linnaeus, 1763), Mytella sp. (Soot-Ryen, 1955) and Crassostrea rhizophorae (Guilding, 1828). Braz J Biol. 2007 Nov;67(4):787-8.

14. Objectives • General • To demonstrate the effect of taking mangrove crab soup meal on the improvement of dengue patient condition • Specific • To evaluate the pletelet count • To evaluate the clinical symptom*

15. Clinical symptom • Headache • Myalgia& athralgia • Fever • Rash • Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.), McGraw Hill. pp. 592. ISBN 0838585299.

16. Methodology • Patient clinically diagnosed dengue admitted • Patients randomized into two groups(sex, age matched) • Baseline blood investigation taken • Supportive treatment commenced • One will received mangrove crab soup as the first meal since admission • Platelet monitored from the usual BD/QID blood investigation • Temperature, symptoms, length of stay recorded

17. Patient selection Inclusion criteria • All patient admitted clinically diagnosed as dengue • Age 18 years old & above Exclusion criteria • Allergy to seafood • Patient in shock / intubated

18. Sample Size • A Pilot Study • 30 patients required for each group (Central Limit Theorem-for normal curve distribution) • Age, sex matched

19. The soup • Using Mangrove crab • Prepared in the form of soup • Steps of preparation will be standardized (after discussion with dietitian/nutritionist) • Served as the first meal and completed until three doses • Each meal contains 500 ml, to be taken with the ordinary meal served by hospital

20. The crab • Mud Crab (Scylla serrata) is also known as Mangrove Crab. It is commonly farmed in Southeast Asia. • Is it halal? Is it the same with ketam batu?

21. Hukum Memakan Ketam Nipah menurut Mazhab Syafie (terbitan Panel Kemusykilan Agama,JAKIM) • Ketam Nipah bukanlah daripada jenis reptilia dan amfibia, tetapi ia adalah dari jenis rustasia iaitu sama golongan dengan udang dan kerang. Keseluruhan edaran hidupnya adalah di dalam air dan mempunyai sistem pernafasan melalui insang dan bukan paru-paru. Ia bernafas menggunakan oksigen dalam air sebagai pelarut.Kehidupan ketam Nipah di darat hanya dalam tempoh masa yang singkat sahaja iaitu lebih kurang 2 atau 3 hari, kerana dalam insangnya mempunyai satu ruang pintu yang boleh ditutup dan mengandungi sedikit air. Ia menggunakan air tersebut untuk pernafasan dan sekiranya air itu kering ia akan mati. • Oleh itu dari segi hukum Ketam Nipah adalah binatang yang boleh dimakan..

22. Ketam Nipah or scientifically called as scylla serrata is indeed a real crab that lives in water, got gills for respiration and what differentiate it with Ketam Batu is the Flipping Leg. The last rear legs are meant for swimming. • The Ketam Batu, all the legs are sharp pointed, mainly for walking, therefore HARAM

23. Outcome • New supportive measure to expedite recovery of dengue patient • Reduce the load of platelet usage for transfusion • Shorten the hospital stay • Improve quality of life • Treating nature’s disease using nature’s gift

24. Thank you