Clinical and Lab profile of severe and uncomplicated malaria: A prospective study from Khuzdar Balochistan.

OBJECTIVES: Khuzdar, the largest city of Southern Balochistan, is endemic for malaria with API of 6. The study was aimed at comparing the clinico-lab profile of severe and uncomplicated malaria in the region and to determine any association with age. No such study is reported in the region so far. METHODS: A prospective clinical observational study was conducted in Combined Military Hospital, Khuzdar between 2018 and 2020. A total of 210 Malaria patients, irrespective of age and gender were included. Cases were categorized into severe and uncomplicated according to WHO criteria. The clinical parameters and lab profile of severe and uncomplicated cases were compared and data was analyzed using SPSS 23.0. Categorical variables were analyzed for association of clinical features with severe malaria using Fisher exact test. Continuous variables were compared between uncomplicated and severe malaria using Mann-Whitney U -test. Statistical significance of lab parameters with type of malaria was derived using Kruskal Wallis. RESULTS: Uncomplicated and severe cases were 191 (91%) and 19 (9%) respectively. Severe malaria was significantly associated with jaundice, bleeding from gums, epistaxis, pallor, vomiting, respiratory distress, thrombocytopenia, low Hb, raised serum bilirubin and raised PT (p value<0.05). In children, frequency of multiple complications was significantly higher than adult patients. (75% vs 25%, p-value 0.002).Overall case fatality of severe malaria was 5.2% (1/19). However, case fatality rate was 100% in cerebral malaria. CONCLUSIONS: Certain clinical and lab parameters can be used to predict prognosis and thus avoid adverse outcome in malaria patients.

Comparison of real time polymerase chain reaction with microscopy and antigen detection assay for the diagnosis of malaria.

OBJECTIVE: To determine the sensitivity of a real time polymerase chain reaction (PCR) for malaria diagnosis and to compare its accuracy with microscopy and an antigen based rapid diagnostic test (OptiMal). STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Military Hospital, Armed Forces Institute of Transfusion and Armed Forces Institute of Pathology, Rawalpindi, from July to December 2011. METHODOLOGY: Venous blood samples of 300 clinically suspected patients of malaria were tested for malaria parasite by microscopy and OptiMal; and malaria parasite index was calculated for the positive samples. Plasmodium genus specific real time PCR was performed on all specimens, targeting small subunit rRNA gene. Diagnostic accuracy of three tests was compared and cost analysis was done. RESULTS: Out of 300 patients, malaria parasite was detected in 110, 106 and 123 patients by microscopy, OptiMAL and PCR respectively. Real time PCR was 100% sensitive while microscopy and OptiMal had sensitivity of 89.4% and 86.2% respectively. All methods were 100% specific. The cost per test was calculated to be 0.2, 2.75 and 3.30 US$ by microscopy, OptiMal and PCR respectively, excluding the once capital cost on PCR equipment. CONCLUSION: Genus specific real time PCR for the diagnosis of malaria was successfully established as a highly sensitive and affordable technology that should be incorporated in the diagnostic algorithm in this country.

Cancer data analysis in the pathology department, combined military hospital, Multan, Pakistan 2002-2007.

This study was conducted with the objective of providing the pattern of cancer distribution from a hospital based tumour registry at CMH, Multan, in comparison with patterns from other National Studies. The retrospective study of malignant tumours recorded at the pathology department from 2002-2007 featured analysis in terms of age group, gender and type of tumour. Over the six year period the total number of malignancies was 930 with a male to female ratio of 1.4:1. The common tumours in males, in order of decreasing frequency were leukaemia, prostate cancer, urinary bladder cancer, skin cancer and lymphomas. In females they were leukaemia, breast cancer, skin cancer, gallbladder cancer and lymphomas. In both sexes, the most common malignancy was leukaemia, which is contrary to other studies, pointing to a possible link with extensive use of pesticides and other agricultural chemicals in this region of the country.