destruction after infections with Plasmodium falciparum or Plasmodium vivax. OBJECTIVE: Our goal was to investigate whether thrombomodulin levels can be used to detect the endothelial cell destruction after tropical or tertian malaria and whether thrombomodulin is related to the severity of tropical malaria. METHODS: This was a cross-sectional observational analytical study conducted in 5 hospitals in north Sulawesi, Indonesia, from June to September 2006, in patients aged 2 to 13 years with tropical or tertian malaria. Thrombomodulin levels were determined with an enzyme-linked immunosorbent assay using a thrombomodulin kit (Fujirebio Diagnostics, Inc, Malvern, PA). Data were analyzed by independent t test and Spearman rank correlation coefficient. RESULTS: For 30 patients with tropical malaria (thrombomodulin level: 0.060 -0.180 FU/mL) and 2 patients with tertian malaria (thrombomodulin level: 0.068 -0.075 FU/mL), there was a significant difference in t-test results between tropical and tertian malaria (P ϭ .044). For 11 patients with severe malaria (thrombomodulin level: 0.086 -0.162 FU/mL), there was also a very significant difference in t-test results for complicated and uncomplicated tropical malaria (P ϭ .009). The Spearman rank test showed significant positive correlation between thrombomodulin and parasitemia levels (r s ϭ 0.686; P ϭ .001). CONCLUSIONS: Thrombomodulin levels can be used to detect endothelial cell destruction in malaria; the thrombomodulin level in tropical malaria was found to be higher than that of tertian malaria. Thrombomodulin levels were very significantly different in complicated and uncomplicated tropical malaria and also correlated significantly with the degree of parasitemia.
Background and aims Fetal hydronephrosis is the most common anomaly detected on prenatal ultrasound examination. Several algorithms exist for its management but it remains controversy until now. Here we present our experience in management and outcome of the patients with prenatal hydronephrosis. Methods In this study 160 known cases of prenatal hydronephrosis were evaluated for detecting underlying aetiology. We carried out renal and bladder sonography and voiding cystourethrography (VCUG) for all patients and DTPA scan in cases with suspicion of obstruction. Results Of 160 cases of prenatal hydronephrosis 75% were boys and 25% were girls. The mean duration of postnatal follow up was 21.5 months (3 months to 36 months). The most common detected abnormalities were ureteropelvic junction obstruction (UPJO) 90 patients,vesicoureteral reflux (VUR) 46 patients, posterior urethral valve (PUV) 15 patients respectively. Nine patients had neurogenic bladder. Prenatal hydronephrosis were unilateral in 83.2% (133 cases). In these cases 57% were on the left side . The grade of reflux was severe in 20 renal units (36.4%), moderate in 24 renal units (43.6%), and mild in 11 renal units (20%). During the follow up period 50 cases (31.25%) resolved spontaneously. 34 cases (21.25%) underwent surgery and 76 (47.5%) are still under medical treatment. Conclusions It is highly suggested to do standard VCUG in all boys with prenatal hydronephsis to detect PUV and neurogenic bladder. Additionally, renal sonography in all cases of congenital hydronephrosis and DTPA in cases with indication is recommended.
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