The document summarizes a study on malaria cases admitted to a military fever hospital in Egypt between 2018-2022. It finds that the majority of cases were young male military staff from Greater Cairo with a history of previous malaria infections. Nearly half of cases were uncomplicated, while over a third had severe non-cerebral malaria. Complicated cases were more likely to have disturbed consciousness, vomiting, jaundice and require ICU admission.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Cost of hospitalization for foodborne diseasesILRI
Presented by Teng Srey, Communicable Diseases Control Department, Ministry of Health, Cambodia at the Safe Food, Fair Food for Cambodia project final workshop, Phnom Penh, Cambodia, 21-22 June 2021
Francesca Torriani, M.D., of UC San Diego Owen Clinicm, presents "Update on International CFAR Grant on Tuberculosis and HIV Screening in Healthcare Workers at Maputo Central Hospital in Mozambique" at AIDS Clinical Rounds
Cost of hospitalization for foodborne diseasesILRI
Presented by Teng Srey, deputy director, Centers for Disease Control and Prevention (CDC) Cambodia at a Taskforce and Stakeholder meeting, 24-25 October 2019 in Siem Reap, Cambodia.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Cost of hospitalization for foodborne diseasesILRI
Presented by Teng Srey, Communicable Diseases Control Department, Ministry of Health, Cambodia at the Safe Food, Fair Food for Cambodia project final workshop, Phnom Penh, Cambodia, 21-22 June 2021
Francesca Torriani, M.D., of UC San Diego Owen Clinicm, presents "Update on International CFAR Grant on Tuberculosis and HIV Screening in Healthcare Workers at Maputo Central Hospital in Mozambique" at AIDS Clinical Rounds
Cost of hospitalization for foodborne diseasesILRI
Presented by Teng Srey, deputy director, Centers for Disease Control and Prevention (CDC) Cambodia at a Taskforce and Stakeholder meeting, 24-25 October 2019 in Siem Reap, Cambodia.
NCCR 2020: Conference Of Very Important Disease (COVID-19) | 24 - 26 August 2020
Young Investigator Awards Presentation
Wan Shakira Bt Rodzlan Hasani
(Institute for Public Health, NIH)
https://doi.org/10.5281/zenodo.4004583
DIAGNOSIS OF PEDIATRIC INFECTIOUS DISEASES - Slideset by professor Susanna Esposito, president WAidid, presented at the 7th International Congress of Laboratory and Clinic, held in Tehran (Iran) from 12 to 14 February 2015
Impact of Emergency Presentation on Colon Cancer Surgical Stay and OutcomesRamzi Amri
Abstract, Academic Surgical Congress 2014:
Introduction:
Urgent presentation is an unequivocal poor prognostic factor in patients with colon cancer. This abstract assesses the magnitude of the negative effects associated with an emergency presentation in patients with surgically treated colon cancer.
Methods:
All patients diagnosed with colon cancer who underwent surgery at Massachusetts General Hospital from 2004 through 2011 were included. Emergency presentation is defined as presentation or referral to our center requiring immediate surgical treatment following diagnosis of colon cancer that was subsequently confirmed through pathology. We compared dichotomous outcomes among emergency and elective patients using the Chi-square test and a relative risk (RR) calculation, while linear regression was used for continuous outcomes, the unstandardized B regression coefficient was used as a point estimate of differences in time-related outcomes.
Results:
We included 1071 patients, of whom 97 were emergency admissions, 79 of which came from our Emergency department. Emergency patients required longer surgeries (median duration 141 vs. 124 minutes, P=0.026), had a median of three day longer length of stay (P<0.001),><0.001)><0.001),><0.001) rates.
Conclusions:
Emergency presentation is predictive for more advanced disease and far worse outcomes. Longer surgeries, stays, and higher readmission rates means these presentations will also lead to significantly higher healthcare costs. This is another strong argument for preventive care and screening colonoscopy.
The presentation gives an overview on chlamydia among young Europeans and existing control activities in EU/EEA Member States. It refers to the ECDC Guidance on Chlamydia control that was published 2015 and outlines challenges to chlamydia control.
Presentation in the ECDC symposium at IUSTI Europe conference 2016, Budpaest, Hungary.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Norhayati Mokhtar, Public Health Physician at the Vector Borne Disease Sector, Disease Control Division, Ministry of Health Malaysia
#dengue #WorldNTDDay #BeatNTDs
NCCR 2020: Conference Of Very Important Disease (COVID-19) | 24 - 26 August 2020
Young Investigator Awards Presentation
Wan Shakira Bt Rodzlan Hasani
(Institute for Public Health, NIH)
https://doi.org/10.5281/zenodo.4004583
DIAGNOSIS OF PEDIATRIC INFECTIOUS DISEASES - Slideset by professor Susanna Esposito, president WAidid, presented at the 7th International Congress of Laboratory and Clinic, held in Tehran (Iran) from 12 to 14 February 2015
Impact of Emergency Presentation on Colon Cancer Surgical Stay and OutcomesRamzi Amri
Abstract, Academic Surgical Congress 2014:
Introduction:
Urgent presentation is an unequivocal poor prognostic factor in patients with colon cancer. This abstract assesses the magnitude of the negative effects associated with an emergency presentation in patients with surgically treated colon cancer.
Methods:
All patients diagnosed with colon cancer who underwent surgery at Massachusetts General Hospital from 2004 through 2011 were included. Emergency presentation is defined as presentation or referral to our center requiring immediate surgical treatment following diagnosis of colon cancer that was subsequently confirmed through pathology. We compared dichotomous outcomes among emergency and elective patients using the Chi-square test and a relative risk (RR) calculation, while linear regression was used for continuous outcomes, the unstandardized B regression coefficient was used as a point estimate of differences in time-related outcomes.
Results:
We included 1071 patients, of whom 97 were emergency admissions, 79 of which came from our Emergency department. Emergency patients required longer surgeries (median duration 141 vs. 124 minutes, P=0.026), had a median of three day longer length of stay (P<0.001),><0.001)><0.001),><0.001) rates.
Conclusions:
Emergency presentation is predictive for more advanced disease and far worse outcomes. Longer surgeries, stays, and higher readmission rates means these presentations will also lead to significantly higher healthcare costs. This is another strong argument for preventive care and screening colonoscopy.
The presentation gives an overview on chlamydia among young Europeans and existing control activities in EU/EEA Member States. It refers to the ECDC Guidance on Chlamydia control that was published 2015 and outlines challenges to chlamydia control.
Presentation in the ECDC symposium at IUSTI Europe conference 2016, Budpaest, Hungary.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Norhayati Mokhtar, Public Health Physician at the Vector Borne Disease Sector, Disease Control Division, Ministry of Health Malaysia
#dengue #WorldNTDDay #BeatNTDs
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
13. Malaria is a vector-borne disease that affected over 200 million
people in 2019. And imposes a significant economic burden on
endemic countries. According to the 2019 WHO malaria report,
19 countries collectively account for 85% of global malaria
burden (WHO, 2019).
All of these high-burden countries are also resource poor, and
(except for India) are located in sub-Saharan Africa (SSA). In
these countries, Plasmodium falciparum and P. vivax infections
account for the majority of malaria cases (WHO, 2019).
14. In Egypt, malaria has been endemic in all governorates, Recent
data strongly suggested that malaria is re-emerging in the
country where 24 locally contracted cases were reported in
Aswan governorate in 2014 (El-kady et al., 2017).
Also, available epidemiological evidence suggests that in areas
where malaria was eliminated, but the vectors still exist, there
is a risk of re-emergence of the disease (Dahesh and Mustafa,
2015).
15. This particular situation applies to Fayoum governorate as it
was the last focus of malaria, and the main mosquito vectors
are still prevalent (Saleh et al., 2016), therefore a potential for
resurgence exists.
16.
17. Interrupt malaria transmission and reduce mortality in
endemic areas.
Decrease the economic burden of malaria by the proper
treatment.
18. To estimate the prevalence of malaria infection among
cases admitted to military fever hospital.
To describe the epidemiological and clinical
characteristics of the patients Admitted to the Fever
Hospital who proved infected with malaria.
To differentiate between severe and uncomplicated cases
of malaria by Clinical presentation, platelet count and
blood film.
19. To study the incidence of thrombocytopenia in patients
admitted to the military Fever Hospital who proved
infected with malaria.
To study the outcome and the efficacy of treatment of
patients admitted to the Military Fever Hospital who
proved infected with malaria.
20.
21. Design and Settings:
• This is a Retrospective cohort study including all patients
suffering of malaria attending a Military Fever Hospital.
• Data was collected from January 2018 to September 2022.
22. In order to evaluate the state of malaria as a cause of fever, 112
patients were selected from those admitted to Military Fever Hospital.
Inclusion criteria:
• Clinical manifestations (Despommier DD, et al., 2019).
• Positive Rapid Malaria Test.
• Positive Blood Film for malaria.
Study population:
Exclusion criteria:
• Negative Rapid Malaria Test.
• Negative blood film of malaria in patients suspected to have Malaria.
24. Full history.
Thorough examination:
Fever analysis as a main complain.
Frequency of clinical symptoms and signs.
Severe malarial manifestations.
Laboratory Investigations (CBC, liver function and kidney
function).
Serological tests.
Ultrasonography; A real time scanning device.
Tool of the study:
25. Methods
a) A full detailed clinical assessment and history in the form of
questionnaire was designed for each individual to determine
the risk factors with specific emphasis to age, sex, residence,
occupation and travel history to a country.
b) Serum samples for Rapid diagnostic test:
Malaria P.F/Pan Rapid Test Device (Whole Blood).
Thin blood films.
Thick blood films.
C) Therapy and Follow up.
d) Clinical outcome of the studied cases.
26.
27. Socio- demographic Data
No %
Age (years) Mean± SD 27.0±7.5
Range 20-60
Age groups 20-25 65 58.0
26-30 24 21.5
31-35 10 8.9
36-40 5 4.5
≥41 8 7.1
Gender Males 110 98.2
Female 2 1.8
Occupation Military 102 91.1
None Military 10 8.9
Residence Country Egypt 109 97.3
Outside Egypt 3 2.7
Residence Local Region Great Cairo 40 36.7
Delta region 22 20.2
Alex region 19 17.4
Upper Egypt 17 15.6
Canal Region 11 10.1
28. Geographical distribution for imported cases
and travel history
No %
Travel Country Central Africa 57 50.9
Mali 21 18.8
Sudan 20 17.9
Congo 7 6.3
South Sudan 4 3.6
Tanzania 2 1.8
South Africa 1 0.9
Travel Duration(months) Mean± SD 8.5±4.3
Range 0.15-23.2
Travel Duration ≤ 6 months 48 42.9
> 6 months 64 57.1
Previous Infection No 57 50.9
Yes 55 49.1
No of Infections (n=55) Once 24 43.6
More than one time 31 56.4
Median (Range) 2(1-10)
30. Clinical presentation and prevention strategies
0 20 40 60 80 100
Fever
Vomiting
Disturbed Conscious Level
Jaundice
Symptoms
and
signs
100
47.3
23.2
18.8
Percentage
Bar chart representing symptoms and signs among studied patients
31. Clinical presentation and prevention strategies
laboratory investigations Normal level Mean SD Median Minimum Maximum
Total Bilirubin(mg/dL) 0.1 to 1.2 1.8 1.9 1.2 0.3 12.0
Direct Bilirubin(mg/dL) 0.0 to 0.3 0.9 1.2 0.5 0.1 8.2
Albumin(g/dL) 3.4 to 5.4 3.8 0.7 3.9 1.7 5.6
ALT(u/L) 7 to 55 40.5 28.9 31 11 208
AST(u/L) 8 to 48 42.1 28.2 34 12 176
Creatinine(mg/dL) 0.7 to 1.3 1.1 0.3 1.1 0.6 2.4
Urea(mg/dL) 6 to 24 40.4 15.7 38.5 12 105
HB(g/dl) 12 to 16 12.0 1.9 12 6.3 16.2
RBCs(/L) 4.0 to 5.9 x
10*12
4.4 0.9 4.5 2.1 6.4
WBC(ML) 4,500 to
11,000
6.3 1.8 6.3 2.2 11.9
Platelet count /Day 0(ML) 150,000 to
450,000
88.5 51.5 81.5 11 306
Platelet count /Day 3(ML) 150,000 to
450,000
121.2 55.5 110 20 298
Platelet count /Day 7(ML) 150,000 to
450,000
213.6 68.5 202 20 440
Descriptive statistics of laboratory investigations
32. Clinical presentation and prevention strategies
Bar chart representing Prevention strategies among studied patients
0
10
20
30
40
50
60
70
80
90
100
Health Education Chemoprophylaxis
(Doxy)
Mosquito Control
100
83.9 83
Percentage
33. Treatment, severity of cases and related outcome
No %
Severity Sever (Cerebral) 27 24.1
Severe (Non Cerebral) 35 31.3
Uncomplicated 50 44.6
Treatment Artimethenine Derivatives oral 50 44.6
Artimethenine Derivatives IV 35 31.3
Quinine IV 27 24.1
Treatment Duration(days) Mean± SD 9.3±2.8
Range 3-17
Complications Uncomplicated 50 44.6
Complicated 62 55.4
Outcome Cured 110 98.2
Died 2 1.8
ICU Admission No 85 75.9
Yes 27 24.1
34. Comparison between complicated & non-complicated malaria
Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Age(years) Mean ±SD 25.6±5.4 28.1±8.7 0.063
Range 20-46 21-60
Gender Male 50(45.5) 60(54.5) 0.501
Female 0 2(100.0)
Age group 20-25 32(49.2) 33(50.8) 0.088
26-30 13(54.2) 11(45.8)
31-35 2(20.0) 8(80.0)
36-40 0 5(100.0)
≥41 3(37.5) 5(62.5)
Occupation None Military 2(20.0) 8(80.0) 0.100
Military 48(47.1) 54(52.9)
35. Comparison between complicated & non-complicated malaria
Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Residence country Egypt 50(45.9) 59(54.1) 0.252
Outside Egypt 0 3(100.0)
Residence Region Great Cairo 13(32.5) 27(67.5) 0.105
Alex region 13(68.4) 6(31.6)
Delta region 11(50.0) 11(50.0)
Upper Egypt 9(52.9) 8(47.1)
Canal Region 4(36.4) 7(63.6)
36. Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Travel Country Central Africa 26(45.6) 31(54.4) NA
Mali 12(57.1) 9(42.9)
Sudan 9(45.0) 11(55.0)
Congo 2(28.6) 5(71.4)
South Sudan 0 4(100.0)
South Africa 0 1(100.0)
Tanzania 1(50.0) 1(50.0)
Travel duration ≤ 6 months 22(45.8) 26(54.2) 0.826
> 6 months 28(43.8) 36(56.3)
Previous Infection No 29(50.9) 28(49.1) 0.177
Yes 21(38.2) 34(61.8)
No. of infections Once 12(50.0) 12(50.0) 0.112
More than one time 9(29.0) 22(71.0)
37. Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Chemoprophylaxis(Doxycycline) No 3(16.7) 15(83.3) 0.009
Yes 47(50.0) 47(50.0)
Mosquito control No 6(31.6) 13(68.4) 0.209
Yes 44(47.3) 49(52.7)
DCL No 50(58.1) 36(41.9) <0.001
Yes 0 26(100.0)
Vomiting No 48(81.4) 11(18.6) <0.001
Yes 2(3.8) 51(96.2)
Jaundice No 50(54.9) 41(45.1) <0.001
Yes 0 21(100.0)
PA US Free 24(96.0) 1(4.0) <0.001
HSM 26(29.9) 61(70.1)
Treatment Artimethenine
Derivatives IV
0 35(100.0) <0.001
Artimethenine
Derivatives oral
50(100.0) 0
Quinine IV 0 27(100.0)
39. Uncomplicated(n=50) Complicated(n=62)
Mean ±SD Mean ±SD P value
Total Bilirubin*(mg/dl) 1.1(0.3-1.8) 1.6(0.4-12.0) <0.001
Direct Bilirubin*(mg/dl) 0.5(0.1-1.0) 0.7(0.1-8.2) <0.001
ALT*(mg/dl) 23.5(11.0-94.0) 41.0(13.0-20.8) <0.001
AST*(mg/dl) 30.0(12.0-67.0) 44.0(12.0-176.0) <0.001
ALB (g/dl) 3.92±0.73 3.68±0.74 0.099
Cr (mg/dl) 1.12±0.23 1.16±0.37 0.557
Urea (mg/dl) 36.82±11 43.21±18.19 0.031
HB (g/dl) 12.75±1.45 11.45±2.1 <0.001
RBCs (/L) 4.65±0.6 4.27±1 0.020
WBC (M/L) 6.3±1.78 6.32±1.88 0.967
Platelet count Day 0 /
(M/L)
121.6±52.41 61.87±31.69 <0.001
Platelet count Day 3 /
(M/L)
157.86±47.97 91.71±42.14 <0.001
Platelet count Day 7 /
microliter
252±54.87 183.26±62.94 <0.001
40. Predictors of the occurrence of complications
95% CI for OR
B S.E. P value OR Lower Upper
Platelet count Day0 -0.041 0.014 0.003 0.959 0.934 0.986
Platelet count Day7 -0.020 0.005 <0.001 0.981 0.971 0.991
PA US 3.032 1.132 0.007 20.74 2.25 190.6
Constant 8.565 1.867 0 5244.0
41.
42. Age of majority of cases was (20-25) years (58%), majority were
males, military staff, Egyptian and from great Cairo.
Nearly half of them reported history of previous infection with median
two times infection episodes and range (1-10) times. The number of
imported cases was the least in 2018 only 2 patients and increased
dramatically in 2019 then declined after that in 2020 & 2021.
Conclusions
43. (44.6%) were uncomplicated while (35, 31.3%) had severe non
cerebral presentation. Majority of patients (85, 75.9%) received
Artimethenine Derivatives either oral (50, 44.6%) or intravenous (35,
31.3%). (55.4%) patients were complicated, (24.1%) needed ICU
admission and only two patients died.
In complicated patients; 26 patients (100%) had DCL compared to
36(41.9%) with no DCL. Complicated cases also had higher rates of
vomiting (51, 96% vs 11, 18.6%), jaundice (21,100.0% vs 41, 45.1%).
Complicated cases had longer duration of treatment compared to non-
complicated cases.
Conclusions
44. Complicated cases had higher levels of total bilirubin, direct bilirubin,
ALT, AST and Urea compared to non-complicated cases, p<0.001. While
had lower levels of Platelet, Hb and RBCs compared to non-complicated
cases, p<0.001.
Platelets count at day 0 and platelets count showed an inverse
association with complications risk, the higher the platelet count the
lesser the risk to be complicated, OR=0.959(0.934-0.986) for platelets
count at day 0 (decrease risk by 5% with each unit increase in Platelet
count).
Conclusions
45.
46. From the results of this study, certain recommendations to the public and
to health professionals are suggested:
Keeping malaria in the differential diagnosis of all acute fevers is
necessary.
Malaria should always be suspected in any febrile patient who has
traveled to an endemic area. There could even be other less common
routes of infection, requiring prompt diagnosis and treatment.
Recommendations
47. Chemoprophylaxis which tends to be ignored and neglected by some
health professionals needs not be emphasized, and from the results of
this study it was clear that many patients have traveled to endemic
areas.
There should be adequate health education for patients living in and
travelling to endemic areas. In addition, there should be awareness of
the possibility of complications in patients who fail to improve clinically.
Alternative drugs may be used in such cases.
Recommendations
48. These observations provide an impetus to study the different issues
related to severe malaria including underlying pathogenesis of severe
disease.
Our study may also prove to be an initiator for further research into
possible genotypic abnormalities that the parasite or its carrier may
have acquired over decades of aggression of insecticides, injudicious
usage of conventional antimalarials, ecological transformations due to
industrialization and possible co-infection with certain viruses.
Recommendations