Over the past decade, increased awareness about leptospirosis disease in developing and industrialized countries has resulted in increased numbers of leptospirosis cases being reported worldwide. About 5% to 15% of leptospirosis patients end up with severe forms of the disease. Complication due to leptospirosis requires monitoring, specific treatments, and intensive care admission, thus increasing the cost of treating severe leptospirosis cases. Currently, we have data on incident and mortality rates, but we do not have data on the number of patients with severe form of leptospirosis or how many patients have complications, and whether or not these complications were resolved. Therefore, we carried out this study to determine the predictive factors for severe leptospirosis cases in Kedah. We conducted a cross-sectional study. The data of patients diagnosed with leptospirosis were obtained from the surveillance unit, Kedah Health Department, through the e-notification system. These data were then sorted according to the hospitals where the patients were admitted. The patients’ medical records were collected, and their information was obtained using a checklist. A total of 456 confirmed leptospirosis cases were included in the study, with 199 patients classified as severe cases and 257 patients as mild cases, based on the Malaysian leptospirosis guidelines. Most patients were male (71.5%) with a mean SD age of 36.62 ± 20.75 years. The predictive factors for severe leptospirosis include abnormal lung sounds (OR: 3.07 [CI 1.58–6.00]), hepatomegaly (OR: 7.14 [1.10–45.98]), hypotension (OR: 2.16 [1.08–4.34]), leukocytosis (OR: 2.12 [1.37–3.29]), low hematocrit (OR: 2.33 [1.43–3.81]), and increased alanine aminotransferase (SGPT ALT) (OR: 2.12 [1.36–3.30]). In conclusion, knowing these predictive factors will help clinicians identify severe leptospirosis cases earlier and develop their treatment plans accordingly, to reduce the complications and death from severe leptospirosis.

The COVID-19 pandemic has claimed numerous lives worldwide. Malaysia documented about 118 mortalities during the second wave of the outbreak. This study aims to assess associated risk factors of the COVID-19 mortalities from 18 th March until 22 nd May 2020. The majority of patients were above 60 years old (69.0%), male (78.0%), and Malaysian citizens (98.0%). The mean age of the mortalities was 64.01 years old (± SD 14.91 years). The major risk factors consist hypertension (52.0%), diabetes mellitus (43.0%), cardiovascular diseases (21.0%), extra-pulmonary solid malignancies (5.0%), cerebrovascular diseases (3.0%), pulmonary diseases (1.0%) and pulmonary malignancies (1.0%). About 23.0% of mortalities were related to established clusters while 5.0% had a history of travelling overseas. The mean survival time was 11.87 days (± SD 9.32 days). Approximately 50.0% of the patient survive until day 10 post-admission. The probability of the patients surviving beyond 30 days post-admission was less than 10.0%. There is a significant difference between groups for having a shorter duration to death for risk factors including age group, history of travelling overseas, attending mass gatherings, and having pulmonary malignancies. The hazard ratio (HR) for pulmonary malignancy is 5.512 (95% CI 0.662, 45.899), mass gathering; 3.434 (95% CI 1.375, 8.579), pulmonary disease is 2.442 (95% CI 0.314, 18.983), travelling overseas; 2.251 (95% CI 0.657, 7.711), extra-pulmonary solid malignancy; 2.165 (95% CI 0.767, 6.112), , and despite the significant result only applied for mass gathering (p-value = 0.008). COVID-19 screening should be mandatory for those who attend mass gatherings as they are the main source of COVID-19 spread in the community during the second wave outbreak in Malaysia.