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

Diagnosis of malaria in children is difficult without laboratory support because the symptoms and signs of malaria overlap with those of other febrile illnesses such as pneumonia. Nevertheless, in many parts of Africa diagnosis of malaria must be made without laboratory investigation. Therefore, a scoring system has been developed to assist peripheral health care workers in making this diagnosis. Four hundred and seven Gambian children aged 6 months to 9 years who presented to a rural clinic with fever or a recent history of fever were investigated. A diagnosis of malaria was made in 159 children who had a fever of 38 degrees C or more and malaria parasitaemia of 5000 parasites/microL or more. Symptoms and signs in children with malaria were compared with those in children with other febrile illnesses to identify features which predicted malaria. Symptoms and signs were incorporated into various logistic regression models to test which were best independent predictors of malaria and these regression models were used to construct simple scoring systems which predicted malaria. A nine terms model predicted clinical malaria with a sensitivity of 89% and a specificity of 61%, values comparable to those obtained by an experienced paediatrician without laboratory support. The ability of peripheral health care workers to diagnose malaria using this approach is now being investigated in a prospective study.
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PMID:Clinical predictors of malaria in Gambian children with fever or a history of fever. 986 3

In a combined retrospective and prospective 4-year study of 6412 children consecutively admitted to St Paul's Hospital, Nchelenge, north-east Zambia, the clinical epidemiology of paediatric disease was described. One diagnosis per admission was noted. Protein-energy malnutrition (PEM) was diagnosed clinically and by means of a modified Wellcome scheme using weight-for-height and Z scores. Correlation coefficients were calculated between monthly admission rates and relative humidity, rainfall and temperature. The age distribution of admitted children showed several distinct groups. Type I (malaria, acute gastro-enteritis, pneumonia and meningitis) had its peak in the 1st 7 months of age, type II (burn wounds and measles) had its main prevalence between the ages of 2 and 4 years, and type III (trauma, typhoid fever, snake bite and tropical ulcer) occurred mainly between 4 and 14 years of age. Admission rates for PEM, PEM subtypes, pneumonia, trauma and snake bite correlated with wet season variables. Malaria and acute gastro-enteritis were extremely common throughout the year. A measles epidemic in the dry season was initially followed by an increase in marasmus, whereas oedematous malnutrition only assumed epidemic proportions associated with a post-measles rise in admission rates of pneumonia. Clinical epidemiological data at the district level is a powerful tool for understanding the pattern of serious paediatric disease in the community.
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PMID:Clinical epidemiology of paediatric disease at Nchelenge, north-east Zambia. 992 74

Sickle cell disease is associated with frequent and often severe infections as a result of immune function impairment and functional asplenia. Also, infection can trigger a vasoocclusive crisis. Pneumococcal bacteremia and meningitis are so severe as to warrant prophylactic penicillin therapy, which has provided a dramatic decrease in early mortality. Bacterial pneumonia is common in patients younger than four years, with most cases being due to S. pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydia pneumoniae. Acute chest syndrome is both a difficult differential diagnosis and a common concomitant of bacterial pneumonia. Osteomyelitis is generally due to a salmonella, most often S. enteritidis; multiple foci are common and treatment is difficult, with some patients developing chronic osteomyelitis with sequestration. Parvovirus B 19 infection causes acute bone marrow failure. Malaria does not result in cerebral malaria but can lead to severe anemia or vasoocclusive crisis, and should therefore be effectively prevented. Antimicrobials are generally selected for efficacy against pneumococci (septicemia, meningitis), Salmonella (septicemia, meningitis, osteomyelitis), and mycoplasmas (pneumonia). Prophylactic therapy is of paramount importance and relies on long-term or lifelong penicillin therapy started at four months of age and on closely-spaced immunizations, most notably against pneumococci, the hepatitis B virus, S. typhi, and H. influenzae. Resistant pneumococcal strains have not been reported to cause prophylactic treatment failures. Conjugated pneumococcal vaccines are effective in protecting infants and should therefore be used in sickle cell patients.
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PMID:[Infection and sickle cell anemia]. 1008 75

Pulmonary manifestations are frequently observed in children, pregnant women and travellers with malaria. The pathophysiology of these pulmonary manifestations is poorly understood but would appear to be secondary to an interaction between the parasitized red cells and the pulmonary capillary endothelium. Bronchitis and pneumonia do not directly compromise outcome but, left unrecognized, the delay in diagnosis and treatment may be fatal. Acute respiratory distress in children is the first cause of overmortality, coming before neurological involvement. The acute respiratory distress caused by severe malaria has no specific characteristics. Iatrogenic complications and pulmonary superinfections must be differentiated. The prevention of pulmonary manifestations associated with malaria can easily be accomplished by limiting water intake and carefully monitoring urinary output and weight. Treatment is the same as for acute flare-ups in combination with symptomatic respiratory treatment when required.
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PMID:[Pulmonary manifestations associated with malaria]. 1010 Mar 46

An anthropological examination is made of the Esan population living in Ekpoma, Egoro-Haoko, OkhuEsan, and Ubiaja in Edo State, Nigeria, during 1988-89. The focus is on the Esan perception of illness, the Esan health behavior, and the treatment of illness. The sample areas are not densely populated due to migration to urban areas. Traditional or Christian religions are practiced. Piped water, good roads, and electricity are inadequate. Polygyny is widely practiced. The Esan people believe illness is caused by people or natural or supernatural forces. The most common illnesses among children are measles, convulsions, and headache, which are attributed to supernatural factors. Diarrhea, vomiting, malaria, smallpox, chicken pox, pneumonia, and tetanus are thought to be due to natural factors. Child mortality due to witchcraft is reduced through the taking of oaths at shrines. Christianity has helped to protect people from the power of witches and wizards. In traditional times, natural illnesses were attributed to poor sanitation, poor nutrition, and lack of good water. Presently, women believe that natural illnesses occur from environmental factors such as overgrown weeds or poor water drainage. Many health programs have improved the situation for prevention and treatment. Adult male illnesses are reported as back and waist pains, sugar disease, hemorrhoids, blindness, and sudden swelling of the body, legs, and knees. Blindness occurs due to supernatural forces caused by a lack of maintaining traditional customs, such as adultery of a wife. When a husband dies of a supernatural illness, the wife is frequently held accountable. Adult females report illnesses from pregnancy, childbirth, and postpartum. Miscarriage, hemorrhage, retention of the placenta, and obstructed labor are considered to be due to supernatural factors subsequent to such behaviors as having sex in the afternoon or in the fields. Traditional treatment is dispensed according to the type of illness and is mainly used by adults. Children are treated more quickly than adults. Cost and distance from health services affects use of modern medicine. Mixes of modern and traditional practices are common.
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PMID:The socio-cultural context of health behaviour among Esan communities, Edo State, Nigeria. 1014 69

Addressing diseases of a high burden with the most cost-effective interventions could do much to reduce disease in the population. We conducted a cost-effectiveness analysis of 40 health interventions in Guinea, a low-income country in sub-Saharan Africa, using local data. Interventions were selected from treatment protocols at health centres, first referral hospitals and national programmes in Guinea, based upon consultation with health care providers and government plans. For each intervention, we calculated the costs (comprising labour, drugs, supplies, equipment, and overhead) in relation to years of life saved, discounted at 3%. The results show that the per capita costs and effectiveness of any intervention vary considerably. Average costs show no clear pattern by level of care, but effectiveness is generally highest for curative hospital interventions. Several interventions have a cost-effectiveness of US$100 per year of life saved (LYS) or less, and address more than 5% of total years of life lost. These include health centre interventions such as: treatment of childhood pneumonia ($3/LYS); rehydration therapy for diarrhoea ($7/LYS); integrated management of childhood pneumonia, malaria and diarrhoea ($8/LYS); short-course treatment of tuberculosis ($12/LYS); treatment of childhood malaria ($13/LYS), and childhood vaccination ($25/LYS). Outreach programmes for impregnated bed nets against malaria cost $43/LYS. Maternal and perinatal diseases, have slightly less cost-effective interventions: integrated family planning, prenatal and delivery care at health centres ($109/LYS) or outreach programmes to provide prenatal and delivery care ($283/LYS). A minimum package of health services would cost approximately $13 per capita, and would address a large proportion (69%) of major causes of premature mortality. This minimum package would cost about three times the current public spending on health, suggesting that health spending needs to rise to achieve good health outcomes.
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PMID:The cost-effectiveness of forty health interventions in Guinea. 1018 95

Studies in animal models and cell lines show that vitamin A and related retinoids play a major role in immunity, including expression of mucins and keratins, lymphopoiesis, apoptosis, cytokine expression, production of antibody, and the function of neutrophils, natural killer cells, monocytes or macrophages, T lymphocytes and B lymphocytes. Recent clinical trials suggest that vitamin A supplementation reduces morbidity and mortality in different infectious diseases, such as measles, diarrhoeal disease, measles-related pneumonia, human immunodeficiency virus infection and malaria. Immune responses vary considerably during different infections, and the available data suggest that the modulation of immune function by vitamin A may also vary widely, depending on the type of infection and immune responses involved.
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PMID:Vitamin A and immunity to viral, bacterial and protozoan infections. 1060 8

A 67-year-old man was referred to us for tonic-clonic convulsions. A review of his history revealed that he had been hospitalized for loss of consciousness, hypotension, and suspected apoplexy at age 67. He had experienced prior tonic-clonic convulsions at age 72 and age 74. He had malaria and tuberculosis in his history but had been otherwise generally well. Physical examination was normal, and his blood pressure was 100/80 mmHg. Laboratory findings were normal except alcalinephosphatase (292 U/l) and gamma-glutamyl transpeptidase(60 U/l). Neurological examination showed alert consciousness, mild upper gaze palsy, slight right-side hemiparesis and left Babinski signs was present. Cranial magnetic resonance imaging showed no abnormality, but cerebral angiography revealed bilateral carotid artery occlusion. There were abundant leptomeningeal anastomoses, and the posterior communicating artery was supplied by the left vertebral artery. Electroencephalography showed a spike wave in the temporal lobe and rebuild-up phenomenon in the right hemisphere. Brain atrophy in the anterior and temporal lobes progressed, and the patient experienced gradual disorientation, delirium and hypobulia. He was eventually bedridden. He also demonstrated repetitive tonic-clonic convulsions. After one convulsion, he remained unconscious and died of pneumonia. Autopsy revealed thickening of the intima and internal elastic lamina in the occluded internal carotid artery. The anterior and middle cerebral arteries showed the same pathological changes. Multiple small infarctions restricted to grey matter were present in the cerebral cortex and may have caused the progressive brain atrophy. There was no myelin pallor in the white matter of the cerebrum. Atherosclerotic changes, senile plaque, and neurofibrillary tangles were seen but were within normal limits. These pathological findings were strongly suggestive of moyamoya disease.
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PMID:[An autopsy case of bilateral carotid artery occlusion with repetitive epilepsy and brain atrophy in a senile patient]. 1068 97

Forty-three cases of imported vivax malaria were notified in the Republic of Kabardino-Balkaria in 1981-1997. These included 40 military men serving in Afghanistan, a citizen from this country, a student of the Kabardino-Balkaria State University, a student of a Nal'chik technological college, and a newcomer from Armenia. Among the patients, urban and rural residents were 27.9 and 72.1%, respectively. 37.2% were detected in the season of effective mosquito infection; new cases of malaria were identified in 41.9%, relapses were found in 58.1% of patients. Analyzing the reasons of late diagnosis of imported malaria suggests that the patients visited health facilities too late due to their poor awareness of a risk for malaria. Out of 43 patients, 62.8% referred to in the first 3 days after the onset, 18.6, 9.3, 9.3, and 2.3% did on days 4-6, 7-15, 16, and after a month, respectively. Their physicians made diagnostic errors in 53% of cases. Acute respiratory disease, influenza, pneumonia, and hepatitis were most commonly diagnosed. They were found in 27.9, 11.6, 4.7, and 4.7%, respectively.
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PMID:[Imported malaria in the Kabardino-Balkarian Republic]. 1070 8

Despite much progress in the specific treatment of diseases in children, some basic management questions remain controversial. Examples for this are fluid management of children with infectious diseases and the control of fever in children. Fluid restriction in children with meningitis has been recommended by several authorities in the field; the basis for these recommendations is reviewed, and reasons are outlined why these recommendations may not be appropriate. Similarly, there are few data on which to base recommendations for fluid management in severe pneumonia and cerebral malaria. Some activities supported by WHO are presented. In the management of fever, opinions vary whether fever is a useful protective factor in combating infections, or whether fever might be harmful and should be lowered. Results of a recent survey of experts on this topic are presented, and the research agenda in the field of supportive management of childhood infections is outlined.
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PMID:Open questions in the case management of sick children. 1074 89


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