Clinical profile of falciparum, vivax and mixed infections of malaria, from a tertiary care hospital, Coastal Andhra, India

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh is one of the endemic areas for malaria. The objective was to study clinical profile and outcome of malaria in both species and mixed infection.Methods: Present study was carried out on 100 patients admitted during the period of November 2016 - October 2018 in Narayana medical college and hospital, Nellore. Malaria confirmed by Peripheral thick and thin smear or Antigen Assay underwent detailed clinical history and physical examination. This was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out Of the 100 patients 58 patients were from rural background, males were predominant, most common age group was 20-30 (34%) followed by 31-40 (31%). Out of 100 patients, 54 patients were falciparum,44 patients had vivax and two had mixed infection. All of the patients had fever followed by chills and rigors (75%), nausea and vomiting (59%), easy fatiguability (28%), pain abdomen (17), cough (14%) in both infections, altered sensorium was seen in only falciparum (20.3%). On clinical examination,70% of the patients had pallor, splenomegaly in 46%, icterus (23%), hepatomegaly (14%) and pedal edema in12 patients were observed. All 0f the patients were treated with appropriate antimalarial drugs for appropriate duration, and all were recovered without any mortality.Conclusions:Malaria is very common disease in our country especially in South India, which is one of the endemic areas. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.

Hyperuricemia is a risk factor for cardiovascular risk?

Background: Uric acid is the end product of purine metabolism in humans degraded by the hepatic enzyme, urate oxidase (uricase), to allantoin, which is freely excreted in the urine. However, during the Miocene epoch (20 to 5 million years ago), 2 parallel but distinct mutations occurred in early hominoids that rendered the uricase gene non-functional. Uric acid (UA) is a known endogenous scavenger, which provides a major part of the antioxidant capacity against oxidative and radical injury.Methods: The present study was conducted over a period of one year on outpatients attending the General Medicine Department at Narayana General Hospital, Nellore. The study was included 998 subjects (500 male and 498 female) and authors excluded other complications. Data were analyzed by SPSS software.Results: Serum uric acid of the subjects were measured. The mean and standard deviation were calculated for all the Biochemical parameter. The significance between the groups was determined using Student t-test for equality of means. The two-tailed P value is less than 0.0001, which is statistically significant. Confidence interval: the hypothetical mean is 1.0000 and the actual mean is 6.4600. The difference between these two values is 5.4600. The 95% confidence interval of this difference from 5.3489 to 5.5711. Intermediate values used in calculations; t = 96.4583, df = 999 and standard error of difference p = 0.057.Conclusions: About 53% of the subjects of the study are hyperuricemia, with about 74% of these subjects (or about 39% of the total) diagnosed with hypertension or diabetes mellitus or both, indicating a high CVD risk.

Clinical study of hypertensive crisis at a tertiary care hospital of South India

Background: Hypertensive crisis is a severe clinical condition in which sudden increase in arterial blood pressure can lead to acute vascular damage of vital organs. So timely detection, evaluation and adequate treatment are crucial to prevent permanent damage to vital organs. The aim of the present study is to evaluate incidence and clinical presentation of hypertensive crisis in relation to age, sex, severity of hypertension, accompanying symptoms and clinical manifestations.Methods: It is a clinical prospective study done during the period between January to June 2018 at Narayana Medical College, Nellore. All patients who were more than 18 years with blood pressure>180/120 mmHg to the emergency, outpatients, and inpatients were included. A thorough History and clinical examination was done and necessary investigation was sent to the laboratory.Results: The study results indicate that males (64%) were significantly over represented compared to females (36%). Out of 50 patients majority of the subjects belonged to age group of 50-59 years. Out of 50 Patients most common symptom is Headache (48%), Vomiting (48%), Giddiness (38%), Dyspnoea (22%), Loss of consciousness (22%) followed by chest pain (20%), Blurring of vision (20%) and weakness of limbs (14%). Most of the individuals are in the hypertensive emergency (66%) followed by Hypertensive urgency (34%). Out of 50 patients 56% had neurological involvement and 44% had cardiological involvement. Our study states that most of cases were in grade 1retinopathy (8%) followed in order by grade 4 retinopathy (8%), grade 2 retinopathy (6%) and grade 3 retinopathy (6%).Conclusions: The present study concludes that majority of patients present presenting in hypertensive emergency belonged to fifth and sixth decades of age. So, treating physician should rapidly assess the differentiation of hypertensive emergency and hypertensive urgency in order to prevent end organ damage and to prevent further morbidity and mortality.