Clinical diagnosis of malaria on the Thai-Myanmar border.

BACKGROUND: To evaluate the prevailing practice of presumptively diagnosing malaria in all cases of febrile illness in a clinic serving a refugee population on the Thai-Myanmar border METHODS: A retrospective review of 3,506 patient charts from December 1993 through June 1994 at the MaeSot medical clinic to compare clinical signs of malaria to blood smear findings. Patients presenting without fever were assumed not to have malaria; the remaining 2,111 patients presenting with fever had blood smears examined for malaria infection. RESULTS: Fever alone sufferedfrom poorpositive predictive value (54.7 percent) and specificity (59.3 percent). When fever was combined with hepatosplenomegaly and anemia, the positive predictive value and specificity improved (84.5 percent and 98.5 percent, respectively). However, this combination also resulted in an unacceptably poor sensitivity (16.5 percent) and false negative error rate (835/1,000). CONCLUSIONS. In this nonimmune refugee population, severe complications of falciparum malaria occur quickly and commonly; aggressive chemotherapy is necessary to reduce morbidity and mortality. Until laboratory facilities are made available, all cases offever should continue to be treated presumptively as malaria.

Detrimental results with the common inflared shoe: clinical questioning of a historic alignment concept.

The detrimental results of shoe use manifested both in the foot and in footwear were studied and found to support earlier views that inflared alignment is a significant factor in foot damage. Mechanical implications of alignment also confirmed our impression that the inflared alignment is a deleterious influence. Absence of conclusive physiologic evidence justifying inflaring and the death of end results from use of standard straight last footwear for comparative evaluation suggest that further inquiry regarding this feature is warranted, with view to its elimination.