Treatment of severe falciparum malaria: quinine versus artesunate.

Background: Malaria is the most important disease of human being. More than 40% of the world’s population is considered to be at risk of exposure of this disease. Malaria infection has been increasing over recent years due to combination of factors including increasing resistance of malarial parasite. Most of the strains of P. falciparum are now resistance to conventional drugs like chloroquine in many areas. The objective of this study was to compare the efficacy and safety of quinine and artesunate in treatment of P. falciparum malaria. Methods: This is hospital based prospective study, conducted amongst 35 randomly selected patients of severe P. falciparum malaria. Patients with any contraindications of either drug were excluded to avoid bias. Standard statistical tests were applied for qualitative as well as quantitative data. Results: As per the study end point results of difference of mortality in patients receiving either drug was not significant (p > 0.75), but difference in clinical parameters like fever clearance time (p <0.01), parasite clearance time (p < 0.001) and coma resolution time (p < 0.001) were significant among patients receiving artesunate. There were no any significant differences in adverse effects of both the drugs. Mortality was same in both arms taking either drug. Conclusions: Artesunate is as good as quinine in mortality aspect but artesunate is superior in fever clearance time (FCT) & parasite clearance time (PCT). Coma resolution time is faster with quinine as compared to artesunate. There are no significant adverse effects of either drug. So artesunate is equivalent or superior for treatment for severe falciparum malaria. Key words: Severe falciparum malaria, Quinine

Kartagener’s syndrome : A rare case.

Primary ciliary dyskinesia (PCD) is a syndrome characterised by productive cough with bronchiectasis and sinusitis early in life and reduced fertility later in life. PCD is a rare syndrome with an estimated incidence of 1: 20,000 to 30,000 . Primary ciliary dyskinesia is a genetic disorder which manifests early in life and that distinguish it from the acquired mucociliary disorders . Here we discuss one such case of Kartagener’s syndrome that presented to us with bronchiectasis , recurrent sinusitis with primary infertility and situs inversus , all of which which fit into the triad of Kartagener’s syndrome.

A case study on wilson’s disease (westphal- strümpell pseudosclerosis).

Wilson disease of Progressive Lenticular Degeneration is a familial nervous disease associated with Cirrhosis of the Liver. It has been observed that there is an increased copper content of the liver and brain. Increased excretion of copper in patients with Wilson disease & increased even more after administration of the chelating agent British anti-Lewisite (BAL). Ciruloplasmin, serum protein that binds copper, is reduced. The deposition of copper in tissues is the cause of virtually all the manifestations of the disease in Liver Blood Kidney & Brain We have observed three different cases of different clinical presentations.