Randomized control trial of quinine and artesunate in complicated malaria.

OBJECTIVE: To study the comparative efficacy of the quinine and artesunate in complicated malaria in children. METHODS: All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P. falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests. RESULTS: 80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 +/- 31.49 hrs; 43.55 +/- 20.12 hrs, and 41.67 +/- 16.78 hrs respectively) as compared to the quinine group (70.15 +/- 17.56 hrs, 62.23 +/- 16.99 hrs, and 52.24 +/- 12.69 hrs respectively) ( p<0.05) No side effects were observed in the artesunate treated group. CONCLUSION: Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution, fever clearance, parasite clearance and better tolerability.

Malabsorption in thyroid dysfunctions.

Studies of intestinal absorptive functions in 11 hyperthyroid and 14 hypothyroid patients showed that steatorrhoea was common in hyperthyroid patients and rare in hypothyroid patients. D-xylose malabsorption was present in both the groups of thyroid disorders being more common in hypothyroid one. Occasionally vitamin B12 malabsorption was found in 2 hypothyroid patients. Jejunal mucosal changes were almost unremarkable. Both fat and carbohydrate malabsorption in both groups of patients appeared to be casually related to the thyroid dysfunction.

Early onset duodenal ulcer with special reference to serum alpha-1-antitrypsin activity.

Thirteen patients of duodenal ulcer, below 20 years of age, ten age and sex matched controls and 17 first probands were studied to find out (i) the special characteristics of this duodenal ulcer subtype and (ii) the serum alpha-1-antitrypsin (alpha-1-AT) activity in these patients and their first probands. Basal and maximal acid output, and serum level of alpha-1-AT were measured, and serum agar gel electrophoresis done, in the above subjects. Special characteristics like positive family history, and high basal (p less than or equal to 0.01) and maximal (p less than or equal to 0.001) acid output were noted in these patients. Serum alpha-1-AT was found to be deficient in nine patients. Five first probands also had the heterozygous level of the enzyme deficiency. Thus, patients of early onset duodenal ulcer seem to have special characteristics with alpha-1-antitrypsin deficiency in them as well as in their first probands.