Partial exchange transfusion in the treatment of severe falciparum malaria.

BACKGROUND: Exchange transfusion as an adjunct to the treatment of severe falciparum malaria has been widely recommended, although there is no well-designed clinical trial to prove its efficacy. The amount of compatible blood required for total exchange is rarely available in areas endemic for malaria and the risks of the procedure including transfusion-related infections are high. METHODS: Partial transfusion with four units of blood was given to a patient with severe falciparum malaria (80% parasitaemia) whose condition deteriorated on conventional treatment with intravenous quinine. RESULTS: This brought about prompt clinical improvement and reduction in parasitaemia. CONCLUSION: Partial transfusion with one or two litres of blood is a promising and viable alternative to total exchange transfusion.

Reassessment of frequency of occurrence of typhoid fever and cost efficacy analysis of antibiotic therapy.

Typhoid fever has assumed importance due to the increased incidence of drug resistance in India. The exact magnitude of the problem is not accurately known. The objective of this study was to collect retrospectively the data on the incidence and frequency of typhoid fever among hospital admissions at St. Johns Medical College Hospital (SJMCH), Bangalore during the year 1987 to 1992 and also to study the sensitivity pattern and the use of antibiotics. The study was also aimed at comparison of immunogenicity and tolerance of conventional vaccine to the newer polysaccharide vaccine. It was found that the incidence of typhoid fever showed change from epidemic to endemic situation with outbreaks of epidemics. Sensitivity pattern also showed change during the same period and antibiotic resistance was increasingly demonstrated from 1989. Cost per patient and total cost to the hospital due to increased admissions also showed progressive increase. The polysaccharide vaccine (recently made available in India) had very low adverse reaction profile with higher immunogenicity as compared to conventional vaccine. Its single dose effect with long lasting immunity indicates it probable usefulness in the eradication of disease.

Spirometric indices of early airflow obstruction.

Thirty cigarette smokers and 25 non-smoking controls, all men were evaluated by history, physical examination and simple spirometry. The history and physical examination were not of much use in predicting airflow obstruction. Forced mid-expiratory flow (FEF 25-75%) was abnormally low in 23 of the 30 subjects, while forced expiratory volume in 1 second (FEV1) and FEV1/FVC (forced vital capacity) were less sensitive. Thus simple spirometry is a useful screening tool to detect early airflow obstruction even when it is clinically undetectable.