ABSTRACT
Objectives: to document the spectrum of presenting symptoms, diagnostic investigations, treatment and outcome of severe malaria in the hospitalized children of Kuwait teaching hospital
Methodology: this was a descriptive study using patient case records of children admitted from 1[st] January till 31[st] December 2013. All children with malaria requiring admission and treatment with parenteral anti-malarial were categorized as severe malaria and included in the study. Data was analyzed using Microsoft office Excel 2007
Results: 32 cases fulfilled the inclusion criteria. Fever was the commenest presenting symptoms present in 100% of cases [n=32]. Fifty percent children [n=16] had pallor, 12.5%[n= 4] cough, 9.3%[n=3] had dysuria and 6.25%[n=2] had fits recorded as additional presenting symptoms. 71.8% [n=23] had parasitological confirmation test before commencement of treatment. 100% of this parasitological confirmation was done by peripheral blood smear/microscopy test. Out of the 23 who had microscopy done 60.86%[n=14] had negative result and 39.13%[n=9]were positive for plasmodium of which,88.88%[n=8]were vivax and 11.11%[n=1] was falciparum.93.75%[n=30] of the parenteral anti-malarial used was intravenous quinine. All except one child 96.8%[n=31] recovered with the anti-malarial treatment used
Conclusions: fever and pallor are the two most common presenting symptoms of hospitalized children with severe malaria. Microscopy remained the most common investigation for the diagnosis of malaria. Quinine is the most frequently used drug for severe malaria. The study highlighted the need to further improve the case management of severe malaria in children
ABSTRACT
To analyze the results of flbrinolysis in a large single-center group of patients with prosthetic heart valve thrombosis. This descriptive study was conducted at Rehman Medical Institute Peshawar, Pakistan. A total of 72 consecutive patients presenting with Prosthetic heart valve thrombosis received fibrinolysis treatment between 2003 and 2008. The diagnosis of Prosthetic heart valve thrombosis was established mainly by echocardiography. The fibrinolytic agent used was streptokinase. The outcome of Fibrinolysis treatment was assessed through hemodynamic parameters via echocardiography and also on clinical grounds. Complete success of hemodynamic abnormalities was noted in 61 of 72 patients, partial resolution in 6/72 patients, and failure in 5/72 patients after one or more consecutive fibrinolytic regimens. Only streptokinase was used as a fibrinolytic as previous studies have clearly established its supremacy. One death was reported. Major bleed, requiring transfusion occurred in just one patient. Three documented cerebrovascular accidents with two embolic events and one cerebral haemorrhage occurred during fibrinolysis treatment. These results demonstrate that fibrinolysis treatment is effective in prosthetic heart valve thrombosis, regardless of prosthetic site involved. It also failed to show any significant difference between outcomes of success in different New York Heart Association classes and thus supports FT in New York Heart Association classes I and II as well