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

From July 1989 to February 1990, 17 non-pregnant patients with severe falciparum malaria, aged 14 years and above received an initial intravenous quinine dihydrochloride loading dose of 20 mg/kg in 500 mls of normal saline or 5% dextrose infused over 4 hours followed by 100mg/kg infused 8 hourly for at least 24 hours. Sixteen comparable controls were similarly treated but without an initial loading dose. Oral quinine bisulfate 10mg/kg 8 hourly was substituted for a total of 7 days when patients were well enough. There was no significant difference in clinical and parasitological response between the two groups. Fever clearance time in hours was 44.00 +/- 13.92 (mean +/- SD) in the study group and 51.43 +/- 19.63 (mean +/- SD) in the control group (p > 0.05). Parasite clearance time in hours was 42.40 +/- 9.75 (mean +/- SD) in the study group and 47.05 +/- 7.69 (mean +/- SD) in the control group (p > 0.05). One patient from each group died. Mild toxic effects were common in both groups. Transient partial hearing loss occurred significantly more in the study than control group (p < 0.05). Hypoglycaemia during treatment occurred in 3 (18%) patients in the study group and 1 (6%) in the control group. The mean trough and peak plasma quinine levels in 3 patients per group was persistently higher than 9mg/L after first infusion. We conclude that though fairly well tolerated, quinine loading dose appears to have no advantage over the standard treatment for severe falciparum malaria at Kenyatta National Hospital, Nairobi, Kenya.
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PMID:Quinine loading dose in severe Falciparum malaria at Kenyatta National Hospital, Kenya. 129 31

Identifying the incubation period of HIV infection is important for individual prognoses, for developing and testing intervention strategies, for determining the reproductive rate of the disease, and for prevalence of the disease. Mathematical modeling of HIV infection in Africa is necessitated because the disease is more widespread and the immune system is constantly active due to the exposure to diseases such as malaria and tuberculosis. The Markov model for this analysis was selected because parametric estimation is not based on the time a stage is entered, but on the duration between observations and the stages at the time of observation. The HIV infected female prostitutes in the Pumwani area of Nairobi, Kenya (a population primarily of Tanzanian origin) have been identified as a study population since 1985, and seen every 6 months in clinic, or as needed. Data are constricted by the movement out of the area in the end stage of disease, which is only partially solved by tracking with community health workers. The stages identified in incubation estimation are stage 1: seropositive but symptom free (CDC stage II); stage 2: generalized lymphadenopathy (CDC stage III); stage 3: symptomatic disease (CDC stage IV); and stage 4: death. Data reflect the movement back and forth between stage 1 and 2, between 2 and 3, so the model is not a pure Longini model but rather a timed homogeneous staged model with reversible stages called transition parameters computed in a numerical differentiation. The Fortran computer program for the analyses is available from the authors. The results suggest a quick transition between seroconversion and lymphadenopathy (2.4 months) and unlikely reversal, with the mean waiting time until passage to stage 3 is approximately 2.6 years and conversions are common. Since opportunistic infections are treatable, this makes sense. Assuming a correct model, the estimation of the transition time of 20 months of h34 value of .01 and .05, the mean passage time from stage 1, 2, 3 to 4 (death) is 9.1, 8.9, and 6.2 years 12.9, 12.7, and 10.1 years respectively. The implications are that 1) when infectiousness is hypothesized to be not uniform, peak infectivity occurs earlier in Africa than in the West at least among prostitutes, or 2) if infectivity is constant throughout the incubation period, then HIV transmission must be higher in Africa to explain the high rate of infection.
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PMID:Transition dynamics of HIV disease in a cohort of African prostitutes: a Markov model approach. 217 19

A longitudinal survey was conducted among travellers departing from Nairobi airport to determine the use of malaria prevention measures and assess the risk for malaria while travelling in Kenya. Among 5489 European and North American travellers, 68 different drug regimens were used for prophylaxis, and 48% of travellers used both regular chemoprophylaxis and more than 1 antimosquito measure during travel; 52% of 3469 travellers who used chemoprophylaxis did so without interruption during their travel and for 4 weeks after departure. Compliance was lowest among travellers who visited friends and relatives, who were young, or who stayed more than 3 weeks. Sixty-seven (1%) travellers experienced symptoms of malaria, but the diagnosis could be verified for only 16 of these. Long-stay travellers appeared to be at higher risk for malaria than short-stay travellers, and health information needs to be targeted especially to the former. Similar investigations are needed among international travellers to other malaria-endemic countries. With comparable data available, consistent and effective malaria prevention guidelines can be developed.
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PMID:Malaria incidence and prevention among European and North American travellers to Kenya. 236 79

Major health problems encountered by women in one village situated in the northwestern area outside of Nairobi, Kenya, are addressed in this paper. A retrospective, descriptive account of the nature and cost of health services provided to clients is provided, with a particular focus on the three most critical health problems facing women in that village (which is a prototype of surrounding villages). Female circumcision, childbearing, and malaria are examined, and implications for change are suggested.
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PMID:Major health problems of women in a Kenyan village. 292 31

One hundred and ninety students aged 6 to 18 at a boarding school 120 km west of Nairobi in the Rift Valley participated in a comparative trial of malaria prophylaxis. Treatment with a combination of amodiaquine 25 mg/kg over three days plus doxycycline 100 mg twice daily for five days cleared their blood of Plasmodium falciparum. They were then randomly divided into the following three groups matched for age and sex: one group slept under mosquito nets; one group received one or two tablets (100 mg each) of proguanil hydrochloride daily according to weight; one group received one or two placebo tablets daily which were the same size and colour as the proguanil tablets. Malaria was diagnosed when asexual P falciparum were seen on blood films and was treated with pyrimethamine-sulphadoxine. At the end of one school term 188 of the 190 students had completed the study. One new infection was found during 3893 days of follow up in the mosquito net group, eight new infections over 3667 days in the proguanil group, and 35 new infections over 3677 days in the placebo group, representing a reduction of 97.3% and 77.1% in attack rates for the mosquito net method and for treatment with proguanil respectively. Both provide effective protection from malaria.
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PMID:Comparison of mosquito nets, proguanil hydrochloride, and placebo to prevent malaria. 304 15

In a study in Nairobi, Kenya, 30 young adults with nephrotic syndrome were investigated in detail and a further 18 were studied less completely. In no case was evidence found to support a possible role for malaria in the aetiology of the syndrome.
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PMID:Possible role of malaria in the etiology of the nephrotic syndrome in Nairobi. 455 6

A new species of malaria parasite, Plasmodium (Sauramoeba) heischi, is described from African skinks (Mabuya striata). Eleven individuals of 90 specimens collected in Nairobi were found to be infected. The new parasite is a large species, characterized by spindle-shaped gametocytes, the female often with a subterminal nucleus. The schizonts produce up to 65 nuclei and cause great hypertrophy and distortion of the host cell. Although similar to P. (Sauramoeba) giganteum in dimensions and merozoite numbers, P. heischi is easily distinguished by gametocyte and schizont shapes.
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PMID:A new malaria parasite Plasmodium (Sauramoeba) heischi in skinks (Mabuya striata) from Nairobi, with a brief discussion of the distribution of malaria parasites in the family Scincidae. 651 23

A retrospective analysis of all malaria cases admitted to the Nairobi Hospital was performed by reviewing patient records. Six hundred and three cases were recorded between the period of January 1987 and July 1990 (43 months). The mean age of the patients was 32.5 years and 57.5% were male. Although 81.4% were permanent residents of Kenya, only 18.2% could be said to have lived in a malarial zone. One-quarter of the patients (25.6%) admitted having had a previous episode of malaria, and 57.7% were taking regular chemoprophylaxis. The most common presenting symptoms were fever, headache, vomiting and myarthralgia; the most commonly recorded accompanying signs were jaundice and splenomegaly. Sixty patients met the criteria for severe malaria. During their hospital stay, six patients (1%) died; five of whom were severely ill from the time of for the USA and UK, especially as it represents a selected population of the more serious malarial cases admitted to the hospital. Therefore, it may indeed represent clear evidence to support the hypothesis that a high index of suspicion combined with early diagnosis and treatment will result in improved outcome. Comparative features illustrating these points are presented. As the malaria parasite, P. falciparum, has dynamic antimalarial sensitivity and as more travelers are under threat from this disease, it is vital that ignorance of this danger should not be allowed to put individuals at risk for death. Continuing education of both the traveling public and the medical profession is the only way that both parties will shoulder their respective responsibilities.
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PMID:Nairobi Hospital, Kenya: the management of nonimmune P. falciparum malaria abroad. 825 8

The author is a General Practitioner who worked at the Chogoria Hospital on the eastern slopes of Mount Kenya over the period 1984-86. The rural hospital of 350 beds has an outpatient facility and a large community health department which runs 30 outlying dispensaries. 6 doctors complement a total staff of about 300 Kenyans. The author served as the Director of the community health department in 1985 and 1986. He has since returned to work at the hospital and describes changes which seem to have taken place during his 5-year absence. Over the duration, the population of Nairobi seems to have grown and become more active. Schools are burgeoning with children and the growing population is exercising even greater pressure upon available public services. The community health department's outreach efforts to distribute contraceptives has, however, helped reduce the rate of population growth. Sections briefly describe conditions with malaria, HIV, mycobacteria, women's health, anaesthesia, surgery, and pediatrics. In general, severe infections diseases remain problematic; degenerative diseases are a relative rarity; and oesophageal, stomach, and liver cancers are common, while colonic cancer is unknown.
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PMID:Other people's practices. Kenya. 833 85

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


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