Treatment of uncomplicated plasmodium falciparum malaria with quinine-doxycycline combination therapy.

OBJECTIVE: To assess the efficacy and tolerability of quinine-doxycycline combination therapy in uncomplicated falciparum malaria in terms of malarial parasite clearance from peripheral blood. METHODS: One hundred adult males were included in the study. Malarial parasite counts in peripheral blood films were determined at the time of admission and then 12 hourly until clearance and thereafter weekly for 28 days (4 weeks). Treatment was started with quinine sulphate 10 mg of salt/kg body weight 8 hourly orally for a minimum period of 3 days and maximum of 7 days along with doxycycline 100 mg 12 hourly orally for 7 days. Primary efficacy outcome measure was early treatment failure, whereas secondary efficacy outcome measure was late treatment failure. Tolerability outcome measure was the development of treatment related adverse effects resulting in discontinuation from the study. RESULTS: The primary efficacy outcome measure of the study i.e. malarial parasite index declined from a mean of 6.34 (SD +/- 2.83) before treatment to zero at day 7 of treatment. Parasite clearance time was 1-7 days (mean 3.58, SD +/- 1.28). Mean duration of quinine treatment till clearance of malarial parasites was 4.63 days (SD +/- 1.38). Mean duration of fever was 2.96 days (range 1 to 6 days). There was no early or late treatment failure. There was no relapse during the 28 days follow up period. Drug related side effects were mild and did not warrant discontinuation of treatment in any patient. CONCLUSION: Quinine-doxycycline combination is effective in southern Pakistan. Randomized controlled trials are needed to further validate the claim.

Pattern of the cause of death in adult males - a perspective on autopsy.

OBJECTIVE: To determine the causes of death on autopsy in adult male patients in order to provide a baseline data for health care policy makers. DESIGN: An observational study. PLACE AND DURATION OF STUDY: Pathology Departments of Army Medical College, Rawalpindi and Combined Military Hospital, Kharian, a tertiary care hospital, between 1982-2001. PATIENTS AND METHODS: Data was taken from the autopsy record of the pathology departments and analysed for the causes of death. RESULTS: A total of 626 autopsies performed between 1982-2001 were analysed. Infectious diseases, malignancies and miscellaneous conditions comprised 209, 67 and 350 cases respectively. Infections included tuberculosis (n=62), typhoid fever (n=15), bacterial infections not otherwise specified (NOS) (n=52), parasitic diseases including malaria (n=6), fungal infections (n=12), viral infections (n=13) and infections NOS (n=49). Malignancies included lymphoreticular malignancies, leukemias, astrocytoma, carcinoma lung, liver, pancreas, stomach, gallbladder, renal and metastatic carcinomas. The miscellaneous diseases included accidental/traumatic conditions including one case of intrauterine foetal anoxia (n=59), and systemic and metabolic diseases involving different organs/systems (n=569) with more than one disease in some cases. CONCLUSION: Infections, particularly tuberculosis were a frequent cause of death in this series. The result of the study could indicate that cause of death is useful outcome indicator for disease control programmes.

Cutis marmorata telangiectatica congenita.

A case of cutis marmorata telangiectatica congenita (CMTC) is reported. A young girl had an unusual presentation with sclerosis in the skin lesions, senile features, hypoplasia of the mandible, transverse nail dystrophy, and transverse toe defects resembling Adams-Oliver syndrome. These associated abnormalities are very rare and some have not been documented before with CMTC. The possible relationship of CMTC with Adams-Oliver syndrome is also discussed.