ABSTRACT
Objective: To study the presentations of afebrile malaria with respect to febrile malaria. Study Design: Cross sectional descriptive. Place and Duration of Study: Combined Military Hospital [CMH] Mangla Cantt, from Jan 2015 to Jan 2017
Material and Methods: A retrospective cross sectional descriptive study was conducted on patients received at CMH Mangla during the study period. Permission from the ethical committee of hospital was obtained for the study. Malaria was diagnosed by exam of peripheral blood film slide on Leishman, s stain. Typing of the parasite was done using ICT immunochromatographic strip test. All consecutively advised malarial parasite [MP] tests on febrile and afebrile patients were included in the study. All repeated MP test on the same patients were excluded from the study. No co-incidental/asymptomatic case was diagnosed or included in the study
Results: A total of 5372 MP tests of patients were advised out of which total 1120 cases were reported positive for malaria infection during above study period. A total of 205 cases of suspected afebrile malarial patients were advised MP test. Out of which 116 cases of afebrile malaria were confirmed at Lab. The percentage ratio of total positive MP test was 21%. The ratio of positive febrile to afebrile total MP positive cases was 10:1. Among 116 afebrile patients the presentations were refractory anemia in 42 cases, elevated ALT in 35 cases thrombocytopenia in 3 cases, and jaundice in 8 cases. All presentations of afebrile malarial patients were normalized after antimalarial treatment. Data were analyzed in excel. Descriptive statistics was applied on qualitative variables. Frequency and percentage documented
Conclusion: Malaria without fever is a statistically significant cause of morbidity among patients. Although simple to diagnose and easy to treat, omission of lab diagnosis leads to accumulation of untreated cases of afebrile malaria who are advised expensive and time wasting investigations burdening the Medicare system
ABSTRACT
Objective: To determine the difference between diagnosis and misdiagnosis after medical autopsy
Study Design: Prospective study
Place and Duration of Study: Histopathology Dept Army Medical College Rawalpindi and Military Hospital [MH] Rawalpindi from Jan 2009 to May 2012
Material and Methods: A retrospective cross sectional descriptive study of medical autopsies was conducted on patients at Histopathology Department Army Medical College and MH Rawalpindi who expired at or was brought in dead at MH Rawalpindi during a 41 months period between January 2009 to May 2012. Permission from the ethical committee was obtained for the study. Autopsy for medical purpose was performed on the deceased after receiving written consent from the next of kin. Medical autopsies were performed to determine and find the medical cause of death and to evaluate any disease or injury that may be present. Total of 72 medical autopsies were conducted during the above period. All these consecutive autopsies were included in the study. Ratio of total autopsies done was 0.17% of total hospital deaths at MH Rawalpindi in the duration of study. All subjects were male, military persons, aged between 19 and 50 years. Mean age was 35.5 years. Data was analyzed in excel. Descriptive statistics was applied on qualita ive variables. Frequency and parentages was used
Results: Ante mortem diagnosis confirmed as correct on total of 25/72 Autopsies. Clinically missed / wrong diagnosis was found on 47/72 autopsies
Conclusion: Medical autopsy even today in the environment of a tertiary care hospital has irrefutable contribution in establishing final diagnosis and determining errors and omissions. Consequently it has pivotal role in continued improvement in medical care and in study of evolving disease patterns in real time