Clinical profile and complication of malaria hepatopathy.

BACKGROUND: This study was designed to study the patient characteristics, presenting features and complications of malaria in patients with elevated liver enzymes and to compare these data to those of patients with normal liver enzymes. METHODS: A convenient sample of 100 patients with malaria was selected from three tertiary care referral hospitals. Study subjects were divided into two groups: (1) patients (controls) with normal liver enzymes and (2) patients (cases) with >3 times the normal liver enzymes in the absence of an alternate explanation for such elevation. Patient characteristics, presenting features and complications of malaria in these two groups were studied. Data were collected using a semi-structured pretested proforma and were analyzed using the statistical analysis program SPSS, version 11.5 (SPSS, Inc., Chicago, IL). RESULTS: The mean ages were 38.12 years for the cases and 35.20 years for the controls with a non-significant p value of 0.289. Males composed 82% of the cases that were diagnosed with malarial hepatopathy; the remaining 18% were females. Falciparum malaria was present in 56% of the cases, compared to 12% of the controls. Icterus was present in 66% of cases of malarial hepatopathy, compared to 32% of the controls. Of the 66% of these cases, 18.18% had serum bilirubin >3mg%, whereas out of the 32% of the controls presenting with icterus, only 5.55% had serum bilirubin >3mg% (p=0.003). Of the cases with malarial hepatopathy, 38% suffered from hypoglycemia, compared to 0% of the controls (p<0.001); 84% of the cases presented with thrombocytopenia, compared to 70% of the controls (p<0.001); 12% of the cases suffered from renal failure with serum creatinine levels >2mg%, compared to 2% of the controls (p=0.060). CONCLUSION: Plasmodium falciparum infection (either alone or along with P. vivax) is the leading cause of malarial hepatopathy. Jaundice is a common clinical manifestation among these patients. Patients with malarial hepatopathy have increased incidences of hypoglycemia and thrombocytopenia. Malarial hepatopathy occurs in relation to severe infection, most of which are treated with parenteral artesunate.

Comparison of mean platelet volume in type 2 diabetics on insulin therapy and on oral hypoglycaemic agents.

INTRODUCTION: Increased mean platelet volume is a known risk factor for various acute vascular complications, which is commonly associated with patients with diabetes mellitus. This study was aimed to investigate the association of Mean Platelet Volume (MPV) with Type 2 Diabetes Mellitus (DM) and to know the difference of MPV in patients on oral hypoglycaemic drugs and insulin therapy. MATERIAL AND METHODS: A total of 150 patients were selected and allocated to three Groups of 50 each, referred to as DM Group on insulin therapy, DM Group on oral hypoglycaemic therapy and non-DM Group (Negative control Group). Investigations like fasting blood glucose, HB A1c and MPV were performed. Difference between the means of age, MPV were calculated by analysis of variance (ANOVA) by using Tukey's Honestly Significant Difference (HSD) test. p-value and Confidence intervals were also calculated (p<0.05). RESULT: The outcome of study has shown that values of MPV are increased in patients with Type 2 DM, and are significantly higher in those patients on oral hypoglycaemic therapy than patients on insulin therapy. CONCLUSION: MPV is a simple and cost-effective tool which can be explored for predicting the possibility of acute vascular events in patients suffering from diabetes mellitus. Values of MPV are increased in patients with uncontrolled Type 2 DM, and are significantly higher in diabetic patients treated with oral hypoglycaemic therapy than in those patients on insulin therapy. Early initiation of insulin treatment in confirmed cases of Type 2 diabetics not only helps in controlling blood glucose level but also helps in keeping MPV low and thereby preventing possibility of impending acute vascular events.