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Query: UMLS:C0024530 (malaria)
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This operational study of the performance of aid post orderlies (APOs) at Taril, Southern Highlands Province, Papua New Guinea, was conducted as a follow up to prior operations research workshops and specific research which highlighted the need for adequate medical care. The assessments of the clinical performance (medical history taking, examination, diagnosis, treatment, and advice) of APOs were made by a trained Huli observer in mid-1988. 86 consultations were recorded for children brought to the aid posts for complaints of cough (40), fever (24), or diarrhea (22) and seen by 7 Tari APOs. Data were evaluated by a medical officer who used the recommended Health Department reference. Diagnosis and Treatment of Common Childhood Illnesses for APOs. Results for each illness are provided. APOs made an adequate diagnosis based on the mild and self limiting symptoms, but the medical histories and examinations were too superficial to assess the severity of the illness. Sometimes the level of treatment was inappropriate, i.e., 70% of the children received appropriate cough mixtures and antimalarials for coughs, but over 50% received inadequate doses of procaine penicillin for their age. Several children were not properly referred to the hospital for management of severe dehydration. Treatments were qualitatively correct for the diagnosis made, but inappropriate doses were often prescribed. Information was rarely given to guardians on the need for repeat medications or the signs of treatment failure. There was ample opportunity to reinforce the importance of immunization, adequate nutrition, malaria control, or personal and food hygiene but APOs did not take advantage of the situation. The results reinforce the need for on-site assessment of paramedical workers who are entrusted with frontline care of patients. It has been found that APOs are often neglected by senior staff; there are complaints from APOs that they feel unappreciated by Health Department staff and the community served. Reference is made to a study of rural health services which found that only 585 of officers in charge of health centers had made any supervisory visit in the 2 months preceding the survey. In some provinces APOs sometimes are given a 1-week inservice training period a year. Structural changes, APO selection procedures, education, inservice training, supervision, and support must be addressed in order to overcome some of the apparent weaknesses in the delivery system. The emphasis is on a problem-based approach and education and continued training.
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PMID:Management of common potentially serious paediatric illnesses by aid post orderlies at Tari, Southern Highlands Province. 175 Feb 53

Two Thai girls aged 10 and 13 years from the same rural area were admitted to Paholpolpayuhasena Hospital, Kanchanaburi, Thailand during the rainy season of 1989 with cerebral malaria. After several days of conventional treatment, both developed gangrene involving the feet and toes, but the lesions healed and no other complications were seen. In the absence of convincing clinical and laboratory evidence of vasculitis or coagulopathy, it seems likely that host factors (dehydration, sluggish peripheral circulation, platelet activation, subclinical intravascular coagulation) combined with strain-specific parasite factors (tissue sequestration of mature forms, rosette formation) may predispose to peripheral microvascular occlusion sufficient to produce infarction of tissue in susceptible children. However, despite the apparently ominous appearance of such lesions in a comatose child, the prognosis seems good.
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PMID:Peripheral gangrene in nonfatal pediatric cerebral malaria: a report of two cases. 194 78

Traditionally, blood rheology tests have been used in diagnosis and monitoring of infection, rheumatic diseases and malignancy, and are still of clinical value in these conditions. In the last twenty years, clinical and epidemiological studies have shown that the haematological determinants of blood flow resistance (haematocrit, fibrinogen, white cell count and altered red and white cell rigidity) are also associated with nutritional, metabolic, endocrine and vascular disorders. Decreased red cell deformability may contribute to reduced red cell survival and anaemia in burns, malaria, liver disease and kidney failure. In trauma and inflammatory disease, overt hyperviscosity is usually prevented by vasodilatation and reduction in the haematocrit. However, low-flow states may arise systemically from haemoconcentration (contracted plasma volume, Chapter 3) in severe burns, inappropriate red cell transfusion, or dehydration due to illness; systemically in circulatory shock; and locally in venous thrombosis or arterial disease. In such circumstances, the intrinsic flow resistance of blood may perpetuate flow disturbance, ischaemia and thrombosis. Conversely, optimal levels of haematocrit, fibrinogen and white cell count may be lower than normal in low-flow states. Haemodilution by colloid infusion is beneficial in burns, shock, major surgery, prevention of postoperative venous thrombosis, chronic stable claudication and possibly in acute stroke and retinal vein thrombosis. Plasma exchange may be beneficial in severe Raynaud's phenomenon. Defibrination with ancrod is effective in prevention and treatment of venous thrombosis but its role in arterial disease is unproven. The benefits of streptokinase therapy in venous thrombo-embolism and acute myocardial infarction may be partly rheological, due to fibrinogen depletion. Drugs with rheological effects may be beneficial in intermittent claudication.
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PMID:Blood rheology in general medicine and surgery. 332 67

85 cases of measles with complications have been reported in Agades (Niger) from September 1983 to March 1985. The patients were all adults more than 15 years of age. Such complications are more frequent during winter season. The disease is superposable to the one observed in children: same course, same types of complications (superinfection, undernutrition, dehydration, broken compensation of a parasitosis, encephalitis). Mortality rate is next to the one observed in child (18.2%). Death occurs mainly in women (15 women/1 man). The more often fatal complications are: laryngitis, subcutaneous, emphysema, encephalitis, pernicious malaria, pregnancy complications. It appears highly desirable to extend to adults not yet diseased the immunisation campaign carried out for children.
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PMID:[Complications of measles in adult Africans. Apropos of 95 cases]. 380 54

A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute diarrhea was conducted between 1982-1983 to determine the benefits of oral rehydration therapy (ORT) in treatment of diarrheal illness. At admission, specimens of stool, blood and urine were collected and examine for bacterial, parasitic, and viral agents (including malaria), serum electrolytes, urea, white cell counts and hematocrit. Children were started on oral rehydration solution (ORS) unless severly dehydrated, in which case intravenous therapy was initiated. 84% of the children were successfully treated with ORS alone regardless of etiological agent found; 15% required IV therapy initially, then were placed on ORS. Average hospital stay was 56.2 hours. Cost of treatment by ORT is less than 20% the cost of IV therapy. When investigators surveyed other health institutions, they found that ORT was used alone in less than 10% of all children seen with diarrhea. A side benefit of ORT is the utilization of mothers in preparation and administration of solution, reducing the demand on hospital staff. Since 20% of all pediatric admissions at Kenyatta are due to acute diarrheal disease, use of ORT would reduce costs tremendously. Initiation of ORT at home may prevent development of dehydration altogether.
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PMID:Management of acute childhood diarrhoea with oral rehydration therapy at Kenyatta National Hospital, Nairobi, Kenya. 400 16

To facilitate understanding of the advances in health care in Nicaragua since 1979, this discussion examines them within a historical framework. Nicaragua was occupied by US marines almost continuously from 1909-33. In 1933, their withdrawal left in power the US backed National Guard and the 1st dictator, Anastasio Somoza Garcia. Health conditions under the Somoza regime are difficult to evaluate because lack of data and underreporting were the norm. The health care system under Somoza was administered by 23 separate agencies, including the National Social Security Institute (INSS), a national Ministry of Health, independent local health ministries, and autonomous public hospital governing boards. On July 19, 1979, the dictatorship was overthrown in a popular uprising. Somoza left behind a foreign debt of 1.6 billion dollars, which the Sandinista Front for National Liberation (FSLN) needed to honor to qualify for needed loans. Following Somoza's defeat, the new government faced the problem of how to care for the tens of thousands of persons wounded and how to distribute the aid and medical supplies coming in from other countries. The key to achieving these tasks was popular participation and organization. By the early part of 1980, the new government was addressing more directly the organization of the health care system. Unlike the fragmented services under Somoza, health care in the new Nicaragua fell under the control of a unified Ministry of Health (MINSA). In 1980, the FSLN initiated an intensive campaign against illiteracy, 100,000 young Nicaraguans, called "brigadistas," were trained and sent around the country to teach basic reading and writing. In addition, 1 out of 10 was trained in elementary health principles. They were responsible for educating others about hygiene and basic sanitation as well as distributing antimalarial medication. 5 popular Health Campaigns were waged during 1981 against polio; measles, diphtheria, pertussis, and tetanus; rabies; poor sanitation; and malaria. Since women and children make up about 75% of the population, maternal and child health is a priority. The Sandinistas' approach to diarrhea and dehydration, a major cause of morbidity and mortality in children, has been the creation of over 200 oral rehydration units. The purpose of these units, in addition to the oral replacement of an appropriate salt and glucose solution, is to educate health care workers about the prevention and treatment of diarrheal disease. The education of health care workers also has been a priority. With increased access to health services, there is a chronic shortage of supplies and personnel and capital to build new facilities. International aid has been very important to health. Diverting funds away from Nicaraguan destabilization and toward social needs here in the US would have a positive impact on health services for the people of both Nicaragua and the US.
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PMID:Health care in Nicaragua: a social and historical perspective. 659 13

Low K (LK) sheep red blood cells (SRBCs) serve as a model to study K-Cl cotransport which plays an important role in cellular dehydration in human erythrocytes homozygous for hemoglobin S. Cinchona bark derivatives, such as quinine (Q) and quinidine (QD), are effectively used in the treatment of malaria. In the present study, we investigated in LK SRBCs, the effect of various concentrations of Q and QD on Cl-dependent K efflux and Rb influx (K(Rb)-Cl flux), activated by either swelling in hyposmotic media, thiol alkylation with N-ethylmaleimide (NEM), or by cellular Mg (Mgi) removal through A23187 in the presence of external chelators. K efflux or Rb influx were determined in Cl and NO3 medium and K(Rb)-Cl flux was defined as the Cl-dependent (Cl minus NO3) component. K(Rb)-Cl flux stimulated by all three interventions was inhibited by both Q and QD in a dose-dependent manner. Maximum inhibition of K(Rb)-Cl flux occurred at Q and QD concentrations > or = 1 mM. The inhibitory effect of Q was manifested in Cl, but not in NO3, whereas QD reduced K and Rb fluxes both in Cl and NO3 media. The mean 50% inhibitory concentration (IC50) of Q and QD to inhibit K(Rb)-Cl flux varied between 0.23 and 2.24 mM. From determinations of the percentages of inhibition of the different components of K and Rb fluxes, we found that SRBCs possess a Cl-dependent QD-sensitive and a Cl-dependent QD-insensitive K efflux and Rb influx. These two components vary in magnitude depending on the manipulation and directional flux, but in average they are about 50% of the total Cl-dependent flux. This study raises the possibility that, in SRBCs, the Cl-dependent K(Rb) fluxes are heterogeneous.
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PMID:Quinine and quinidine inhibit and reveal heterogeneity of K-Cl cotransport in low K sheep erythrocytes. 788 11

As part of an evaluation of child survival programmes in 13 African countries, cluster surveys were carried out in two Liberian counties in 1984 and 1988 to measure use of three primary health care services: immunization of infants, antimalarial treatment of children with fever, and oral rehydration of childhood diarrhoea. Immunization rates increased (30-53% for DPT-1 and 13-33% for measles), treatment of malaria with drugs available in the home increased from 5 to 35%, and home use of sugar-salt solution to prevent dehydration remained essentially unchanged, 5.9% in 1984 and 3.8% in 1988.
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PMID:Immunization, oral rehydration therapy and malaria chemotherapy among children under 5 in Bomi and Grand Cape Mount counties, Liberia, 1984 and 1988. 830 75

A 27-year old female from Nairobi was admitted to the medical wards of the Kenyatta National Hospital in May 1991. She presented with a 4-week history of productive cough, fever, weight loss, and night sweats. She acknowledged a history of contact with a patient known to have pulmonary tuberculosis. She has never received a blood transfusion. She was single and para 3 + 0. Examination revealed a sick patient, with moderate pallor, fever of 38 degrees Celsius, and who was wasted with moderate dehydration and oral thrush. There was no finger clubbing, lymphadenopathy, or pedal edema. Chest examination revealed bilateral basal pneumonia. The spleen was palpable 4 cm below the costal margin; the liver was not enlarged. The rest of the examination was normal. On admission, complete blood count showed a haemoglobin of 5.4 g/dl, total white cells were 12.5 x 10-9/L, with 82% polymorphonuclear cells and 18% lymphocytes, erythrocyte sedimentation rate (ESR) was 85 mm/hour, and platelet count was normal. The anemia was normocytic, normochromic, and no malaria parasites were seen. Urea and electrolytes and liver function tests were normal. Sputum showed no acid fast bacilli on Ziel-Neelson Stain. HIV-1 antibodies were positive by enzyme-linked immunosorbent assay (ELISA) and Western blot. Bone marrow aspirate revealed a hypercellular marrow with reversed M:E ration, dyserythropoesis, reticulum cell hyperplasia, plentiful golden yellow pigment, and clumps of Histoplasma capsulatum. Chest X-ray showed bilateral basal pneumonia. She was treated with antibiotics and intravenous fluids, but she remained febrile, her general condition progressively deteriorated, and she died a week after admission. Treatment for histoplasmosis had not been commenced, and no postmortem examination was carried out.
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PMID:Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report. 851 33

The prevalence and likely cause of hyponatraemia in severe childhood malaria were investigated. One hundred and thirty two children, 47 of whom had cerebral malaria, were prospectively recruited and serial simple indices of fluid and electrolyte balance and renal function monitored during admission. In 55%, hyponatraemia (sodium < 135 mmol/l) was present on admission. Hyponatraemia was pronounced (sodium < or = 130 mmol/l) in 21%, and these children gained less weight during admission (mean weight gain 2.4% v 4.3%) than children with a normal sodium (135-145 mmol/l). Overall, 31% of survivors were at least moderately dehydrated on admission (5% weight gain by discharge). These children had higher plasma urea concentrations on admission (6.1 v 4.5 mmol/l) and were more acidotic (mean base excess -12.1 v -8.0) than children who were not dehydrated. There were changes in simple indices of renal function between admission and discharge in children who survived (creatinine 65.7 v 37.9 mumol/l and urea 5.5 v 1.9 mmol/l). The results suggest that dehydration is common in severe childhood malaria, that it may contribute to mild impairment in renal function, and that hyponatraemic children are less water depleted, showing appropriate rather than inappropriate secretion of antidiuretic hormone.
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PMID:Hyponatraemia and dehydration in severe malaria. 878 22


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