Background: Surat is an endemic area for malaria. There has been a change in the trend of clinical profile and severity of P.vivax and P. falciparum malaria. Initially, P. falciparum was considered notorious for its complications but now P. vivax also presents with similar pictures. Hence, vivax malaria, which was once thought to be a relatively benign condition, is appearing in its more malignant form, with severity gradually becoming a serious concern. This aim of the study is to compare the clinical profile severity of P. vivax and P. falciparum malaria in pediatrics age group in a tertiary care hospital in Surat, India. Methods: A retrospective study was carried out at a tertiary care hospital of a medical college in Surat. This study was done for a period of 6 months from July 2014 to December 2014. Patients below 18 years of age who were smear positive for plasmodium species or malarial antigen positive were included in the study. Statistical analysis was done using chi square test for comparing proportions. P value < 0.05 was considered significant. Results: Eighty-seven patients were found to be suffering from malaria detected by malarial antigen test or through blood smear. Out of this, 48 (55%) patients were found to have P. vivax while 31 (35.6%) patients were found to have P. falciparum and only 8 cases had mixed malaria. The common complications encountered were jaundice and severe anemia. Severe malaria was more common in patients having vivax malaria as compared to falciparum. Besides anaemia as a haematological manifestation, thrombocytopenia was the second common abnormality encountered more commonly in patients with vivax as compared to falciparum species. The detailed study morbidity profile clearly establishes that severe malaria, earlier attributed to only falciparum is equally seen in vivax. Conclusions: Severe form of malaria is seen in vivax malaria and the age group affected by vivax also is younger. Profile of complications is different in different studies.
Background: In clinical settings, wasting in childhood has primarily been assessed with the use of a weight-for-height z score (WHZ), and in community settings, it has been assessed via the mid upper arm circumference (MUAC) with a cutoff <115mm for severe wasting and 115-125mm for moderate wasting. Our recent experience indicates that many wasted children were not identified when these cutoffs for MUAC were used.Methods: Authors determined the cutoffs for MUAC to detect wasting in Indian children aged 6-60 mo. A secondary analysis was carried out on data from 1446 children aged 6-59 mo. The area under the receiver operating curve was used to indicate the most appropriate choice for cutoffs that related MUAC with WHZ. The MUAC measurement of each subject was taken using standard technique. Following the World Health Organization (WHO) age and sex-specific cut-off points, nutritional status of children was determined.Results: The mean±SD age for the entire group was 19.8±13.6 mo, MUAC was 132±13mm, and 45% of subjects were girls. Age-stratified analyses revealed that, for ages 6-24 mo, MUAC cutoffs were <120mm for a WHZ <-3 and <125mm for a WHZ <-2 with a sensitivity of 68.3% and 64.7%, respectively, and a specificity of 82.6% and 83.4%, respectively; for ages 25-60 mo, MUAC cutoffs were <135mm for a WHZ <-3 and <140mm for a WHZ <-2 with a sensitivity of 63.7% and 65.4%, respectively, and a specificity of 81.6% and 78.3%, respectively.Conclusions: The respective cutoffs for MUAC to better capture the vulnerability and risk of severe (WHZ <-3) and moderate (WHZ <-2) wasting would be <120 and <125mm for ages 6-24 mo, <135 and <140mm for ages 37-60 mo.
Background: The objective of the study to compare the predictive ability of predischarge serum total bilirubin (STB) and clinical factors for significant hyperbilirubinemia (SHB) in newborn to observe the prediction of the hyperbilirubinemia.Methods: In the prospective study, enlist of healthy newborn infants with >35 weeks gestation, in a tertiary hospital in western India. The serum bilirubin between 36-48 hours of age and risk factors for SHB were identified before discharge. SHB was distinct as a bilirubin level that exceed or was within 1mg/dL (17µmol/L) of the hour-specific phototherapy conduct threshold recommended by American Academy of Pediatrics (AAP) guideline on the management of neonatal hyperbilirubinemia.Results: Of 505 infants, 380 infants were included in final analysis, among which 70 babies (22.5%) developed SHB. On univariate analysis STB, gestational age (GA) and percentage of weight loss were found to be predictive of SHB. On multiple logistic regressions, the prognostic ability of predischarge STB is higher than that of percentage of weight loss and GA. The predictive accurateness of predischarge (<48 hours) STB level was comparable to that of percentage of weight loss (AUC=0.88, 95% CI 0.84-0.93). However, the prediction model that combined multiple risk factors such as predischarge STB, GA and percentage of weight loss have the best accuracy for predicting SHB.Conclusions: Combination of specific clinical factors (gestational age and percentage of weight loss) with predischarge serum total bilirubin described best predicts development of considerable hyperbilirubinemia.
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