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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute renal failure (ARF) associated with liver disease is a commonly encountered clinical problem of varied etiology and high mortality. We have prospectively analyzed patients with liver disease and ARF to determine the etiology, clinical spectrum, prognosis and factors affecting the outcome. Other than hepatorenal syndrome patients, out of 221 cases, 66 developed ARF secondary to various liver disease like cirrhosis (n = 29, mortality 8, risk factors-older age p < 0.01, grade III/IV encephalopathy p < 0.05), fulminant hepatic failure (n = 25, mortality 15, risk factor-prolonged prothrombin time p < 0.01), and obstructive jaundice (n = 12, mortality 7, risk factor-sepsis p < 0.01). In these three groups the factors leading to ARF were volume depletion (24), gastrointestinal bleed (28), sepsis (34), drugs (27) [aminoglycosides (9) and NSAID (18)] along with hyperbilirubinemia. Various types of ARF with contemporaneous liver injury were malaria (n = 37, mortality 15, risk factors-higher bilirubin p < 0.001, higher creatinine p < 0.05, anuria p < 0.05 and dialysis dependency p < 0.05), sepsis (n = 36, mortality 22, risk factors-age p < 0.001, higher bilirubin p < 0.01, oliguria p < 0.05), hypovolemia with ischemic hepatic injury (n = 14, mortality 5, risk factors-higher creatinine p < 0.05 and SGPT p < 0.01), acute pancreatitis (n = 12, mortality 4, risk factors-higher bilirubin p < 0.001, higher SGPT p < 0.01, dialysis dependency p < 0.05), rifampicin toxicity (n = 10, no mortality), paroxysmal nocturnal hemoglobinuria (n = 3, no mortality), CuSO4 poisoning (n = 3 mortality 2), post abortal (n = 11, mortality 6, risk factors higher creatinine p < 0.05 and SGPT p < 0.01), ARF following delivery including HELLP syndrome (n = 12, mortality 4, risk factors-higher bilirubin p < 0.01 and SGPT p < 0.01), and of uncertain etiology (n= 14 mortality 4). 133 patients (60.2%), required hemodialysis hemodialfiltration or peritoneal dialysis. ARF associated with liver disease is having high mortality (42.5%). Avoidance of dehydration, hypotension, nephrotoxic drugs and sepsis, with promote dialytic support are necessary to reduce mortality and morbidity.
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PMID:Acute renal failure associated with liver disease in India: etiology and outcome. 1104 Dec 94

Records of 402 children--216 (53.7%) males and 186 (46.3%) females--aged 1-36 month(s), admitted to the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital, Benin city, Nigeria, during July 1993-June 1996, were reviewed to document the relationship between dehydration and malaria parasitaemia. There was a significant association between severity of dehydration and malaria parasitaemia (p < 0.0001). Association of parasitaemia (p < 0.006) with dehydration (p < 0.0001) was significantly more marked in patients with acute watery diarrhoea than in those with persistent and bloody diarrhoea. Parasitaemia was demonstrated in 50.5% of those not initially suspected to have malaria. Parasitaemia was also significantly associated with fever (p < 0.001) and fever coexisting with vomiting (p < 0.01). The prevalence of malaria-associated diarrhoea was 61.7%. More infants (75.6%) than older children had diarrhoea. It was concluded that the prevalence of malaria-associated diarrhoea was high and that children with dehydration are more likely to manifest malaria parasitaemia.
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PMID:Association of malarial parasitaemia with dehydrating diarrhoea in Nigerian children. 1105 68

A descriptive study on the clinical presentation of childhood malaria was conducted in Savannakhet Province, Lao People's Democratic Republic. It is aimed to describe the clinical features and to determine the association between the severity of malaria and the initiation or delay of treatment. A total number of 92 children 1-14 years of age with confirmed malaria diseases were enrolled in this study. Fifty-six cases (60.9%) had illness for less than 3 days before hospitalized and 36 cases (39.1%) for more than 3 days. Twenty-nine cases (31.5%) had self antimalarial medication before admission (9 cases of chloroquine, 16 cases of quinine and 4 cases of artesunate). Ten cases (10.9%) had abnormal consciousness of which 7 cases (7.6%) had confusion but responded to verbal command and 3 cases (3.3%) were in coma not respond to painful stimuli but had reflex. Two cases 2.2%) had convsulsions, 11 cases (12.0%) had dehydration, 47 cases (51.1%) had vomiting, 18 cases (19.6%) had hepatomegaly and 19 cases (20.7%) had splenomegaly. There was a statistically significant association between consciousness levels and the duration of illness before admission < or = 3 days and > 3 days (p = 0.01) while there is no significant difference between parasitemia density and the duration of illness before admission (p > 0.05).
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PMID:Clinical presentation of childhood malaria in Savannakhet province, Lao PDR. 1141 67

We assessed the inter-observer agreement in identification of a range of 24 clinical signs associated with disease presentation in 327 children aged < 5 years admitted to hospital in January-June 1999 in Ifakara, southern Tanzania. Children with diagnoses of malaria, pneumonia, diarrhoea, anaemia and malnutrition were examined independently by 2 clinical officers. Findings were recorded on a standard proforma. The Kappa-statistic was used to assess inter-observer agreement for each sign. Physical signs were more likely to be agreed upon by clinicians if they involved inspection than if they involved auscultation. The signs included in the Integrated Management of Childhood Illness (IMCI) algorithm were found to be largely appropriate (Kappa-scores > 0.41) although there was only fair agreement (Kappa-score 0.21-0.40) in the detection of neck stiffness and chest indrawing and slight agreement in the detection of dehydration (Kappa-score 0.199). All objective neurological signs were less reliably assessed in infants than in older children. The difficulties surrounding the diagnosis of impaired consciousness in young children should increase vigilance in the diagnosis and management of neurological complications of illnesses in infancy.
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PMID:Inter-observer variation in the assessment of clinical signs in sick Tanzanian children. 1205 6

A national program for controlling diarrhea and promoting breastfeeding was launched by the Haitian Government in July 1983 with the aim of reducing the diarrhea mortality rate by 50% over a 3-year period. After almost 2 years of operation, the program is judged to have been successful in terms of the implementation of activities, the preparation and distribution of educational materials, and the mobilization of health workers and volunteers. In 1984, 6875 medical and paramedical personnel, 5500 national scouts, and 5283 people on the community level were trained in oral rehydration techniques. Over 600,000 packets of oral rehydration serum were sold or distributed by a total of 2311 distribution sites. Successes achieved are considered to be due to a combination of institutional, community, multisectorial, and commerical approaches. Although the statistics from 1984 suggest significant program activity, the results of such activities have not been evaluated. For example, the program's impact on the incidence of diarrhea and dehydration or mortality caused by diarrhea remains unknown. Moreover, the 2md aspect of the program--promotion of breastfeeding--has been neglected to date and will be the focus of a separate campaign scheduled to begin in June 1985. There is some evidence that other priorities of the Ministry of Public Health and Population, including vaccinations, nutrition, family planning, and the fight against tuberculosis and malaria, received dwindling attention during the period of the campaign against diarrhea. This seems to reflect the phasic approach of health authorities.
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PMID:The programme for combating diarrhoeal diseases in Haiti. 1231 9

The project for the struggle against childhood diseases began in Rwanda in 1984. Lack of birth spacing, malnutrition, unhealthy environments and infectious diseases sicken and kill children in all of Africa, and many may be alleviated by simple measures. The project focuses on diarrhea and malaria, attempting to reduce mortality by 25%, administering chloroquine to children with fever and pregnant mothers for malaria, and oral rehydration therapy (ORT) for diarrhea. Goals are breastfeeding and gradual weaning being as universal as possible, and proper alimentation for sufferers of infant diarrhea. ORT is expected to be administered by the mother herself, and should reduce the 60% to 70% of diarrhea deaths caused by dehydration. Measles, whooping cough, neonatal tetanus, polio, diphtheria, and tuberculosis among children will be the targets of innoculation campaigns. All of the diseases are major child killers in Africa; measles are responsible for an estimated 31.3% of child deaths from 1 to 4, 10.3% in the 1st year of life. Community oriented primary care of the type necessary to execute these programs is not presently a priority among medical personnel; it should become an important component of medical education. Education to counter ignorance and the designation of the family as the primary instrument of good health will assure child survival and eliminate the need for multiple births to maintain the family.
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PMID:[Program to combat communicable diseases in children]. 1234 Mar 78

Algorithms which specify procedures for proper diagnosis and treatment of common diseases have been available to primary health care services in less developed countries for the past decade. Whereas each algorithm has usually been limited to a single ailment, children often present with the need for more comprehensive assessment and treatment. Treating just one illness in these children leads to incomplete treatment or missed opportunities for preventive services. To address this problem, the World Health Organization has recently developed a Sick Child Algorithm (SCA) for children aged 2 months-5 years. In addition to specifying case management procedures for acute respiratory illness, diarrhea/dehydration, fever, otitis, and malnutrition, the SCA prompts a check of the child's immunization status. The specificity and sensitivity of this SCA were field-tested in Kenya and the Gambia. In Kenya, the Malaria Branch of the US Centers for Disease Control and Prevention tested the SCA under typical conditions in Siaya District. The Quality Assurance Project of the Center for Human Services carried out a parallel facility-based systems analysis at the request of the Malaria Branch. The assessment which took place in September-October 1993, took the form of observations of provider/patient interactions, provider interviews, and verification of supplies and equipment in 19 rural health facilities to determine how current practices compare to actions prescribed by the SCA. This will reveal the type and amount of technical support needed to achieve conformity to the SCA's clinical practice recommendations. The data will allow officials to devise the proper training programs and will predict quality improvements likely to be achieved through adoption of the SCA in terms of effective case treatment and fewer missed immunization opportunities. Preliminary analysis indicates that the primary health care delivery in Siya deviates in several significant respects from performance standards (not counting respirations in the presence of a cough as the primary complaint, not checking for dehydration in cases of diarrhea, and checking immunization records in only 51% of the 235 cases observed). The report is scheduled for completion in early 1994 and will likely provide data vital to the successful adoption of the SCA.
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PMID:QAP collaborates in development of the sick child algorithm. 1234 42

A case of failed peritoneal dialysis in a 5-year-old male nephrotic who developed acute renal failure following severe P. falciparum malaria infection is presented. Peritoneal dialysis (PD) failure was sequel to undetected severe dehydration which occurred during the diuretic phase of the acute renal failure. Pre-dialysis plasma potassium, bicabonate, urea and creatinine concentrations were 6.0mmol/L, 13mmol/L, 28mmol/L and 900mmol/L respectively, after about 22 hours of PD, the plasma K+, HCO-3 Ur and Cr were 5.7mmol/L, 15mmol/L, 32mmol/L and 1,090mml/L respectively. The peritoneal dialysate Ur concentration (3.5mmol and peritoneal Ur clearance (1.85ml/min/1.73m2) were grossly inadequate. There was also, intradialysis hyperglycaemia (12mmol/L owing to massive absorption of peritoneal dialysate solution which contains high concentration of glucose. Hyperglycaemia was corrected with 0.25 units/kg/dose of soluble insulin intravenously, he had two doses. Owing to similarity of clinical and biochemical features of dehydration and ARF, all efforts must be made to exclude dehydration before embarking on PD in patients with renal failure. Failure to exclude dehydration, led to PD failure in this patient.
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PMID:Failed peritoneal dialysis in a dehydrated nephrotic child, in acute renal failure: a case report. 1250 Dec 70

The ability to cryopreserve a stage of Anopheles mosquitoes would facilitate the development of strains incapable of transmitting malaria. Cryopreservation requires that the freezable water in cell systems be removed or rendered incapable of undergoing ice formation. The present study was concerned with the rate at which water is removed from lst instar larvae of Anopheles gambiae by air-drying, with the extent of dehydration that the larvae will tolerate, and with the effect of trehalose and sucrose on both drying kinetics and survival. Eighty-one percent of the larvae are water. Air-drying removes 90% of that water in approximately 20 min. Survivals after partial dehydration are highest if the larvae are rehydrated in 1/2x isotonic saline (0.13 osm); they are poorest if rehydrated in water or 0.13 osm sucrose. In the former, about 34% survive the removal of half the water, but next to none survive the loss of >70% initial water. Prior exposure to 0.2 M trehalose for as little as 1 min slows the drying rate and increases the tolerance of the larvae to dehydration. With 30-min exposure, 88% survive the loss of 50% of their water and 63% survive the loss of 75%. Protection is abolished with 0.4 M trehalose. The results are similar with sucrose. It is substantially reduced if sugar-exposed larvae are briefly washed with water prior to drying. The protection appears not to be related to the decreased drying rate. Rather it appears related, by an unknown mechanism, to the presence of sugar on the outer surface of the larvae.
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PMID:Effects of sugars on the kinetics of drying and on the survival of partially dehydrated larvae of Anopheles mosquitoes. 1283 21

The emergence of drug-resistant forms of Plasmodium falciparum emphasizes the need to develop new antimalarials. In this context, the fatty acid biosynthesis (FAS) pathway of the malarial parasite has recently received a lot of attention. Due to differences in the fatty acid biosynthesis systems of Plasmodium and man, this pathway is a good target for the development of new and selective therapeutic drugs directed against malaria. In continuation of these efforts we report cloning and overexpression of P. falciparum beta-hydroxyacyl-acyl carrier protein (ACP) dehydratase (PffabZ) gene that codes for a 17-kDa protein. The enzyme catalyzes the dehydration of beta-hydroxyacyl-ACP to trans-2-acyl-ACP, the third step in the elongation phase of the FAS cycle. It has a Km of 199 microM and kcat/Km of 80.4 m-1 s-1 for the substrate analog beta-hydroxybutyryl-CoA but utilizes crotonoyl-CoA, the product of the reaction, more efficiently (Km = 86 microM, kcat/Km = 220 m-1 s-1). More importantly, we also identify inhibitors (NAS-91 and NAS-21) for the enzyme. Both the inhibitors prevented the binding of crotonoyl-CoA to PfFabZ in a competitive fashion. Indeed these inhibitors compromised the growth of P. falciparum in cultures and inhibited the parasite fatty acid synthesis pathway both in cell-free extracts as well as in situ. We modeled the structure of PfFabZ using Escherichia coli beta-hydroxydecanoyl thioester dehydratase (EcFabA) as a template. We also modeled the inhibitor complexes of PfFabZ to elucidate the mode of binding of these compounds to FabZ. The discovery of the inhibitors of FabZ, reported for the first time against any member of this family of enzymes, essential to the type II FAS pathway opens up new avenues for treating a number of infectious diseases including malaria.
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PMID:Identification, characterization, and inhibition of Plasmodium falciparum beta-hydroxyacyl-acyl carrier protein dehydratase (FabZ). 1293 Aug 38


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