The Journal of tropical medicine and hygiene
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Comparative Study
APACHE II scoring for predicting outcome in cerebral malaria.
The APACHE II (Acute Physiology and Chronic Health Evaluation) severity-of-disease classification system was used to stratify the prognosis of 72 adult patients with cerebral malaria. Overall mortality was 13.89%. ⋯ High APACHE II score, deep unconsciousness, acute renal failure and acidaemia were identified as poor prognostic factors. We suggest that the APACHE II system is useful for stratifying the prognosis of group outcome in cerebral malaria patients.
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Detailed standardized annual reports are analysed for 17 rural hospitals in four African countries, with admission figures of 1.2 million patients (excluding deliveries) and more than 67,000 deaths over a period of 16 years. The countries involved are Zambia, Tanzania, Kenya and Ghana. Figures on admission, causes of death and clinical case fatality rates are presented per country and per 4-year calendar period for the most important infectious diseases. ⋯ A need for detailed studies with good "standardized" hospital records is emphasized. Representative data are needed from all hospitals in a given catchment area, with defined diagnoses for diseases and details regarding age and sex. This kind of information is highly desirable for planning and operation of curative and preventive medical care in developing countries.
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Histoplasmosis, a disease endemic to North America, is caused by Histoplasma capsulatum. To the best of our knowledge, the chronic cavitary pulmonary histoplasmosis patient described here presents the first case in which the fungus was isolated from sputum culture in Turkey.
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Case Reports
Intracranial tuberculoma and hydrocephalus developing during treatment of tuberculous meningitis.
A 3 1/2-year-old boy with tuberculous meningitis is described. He developed hydrocephalus and subsequently an intracranial tuberculoma while receiving appropriate antituberculous therapy. Such a paradoxical response is thought to be due to a hypersensitivity reaction to the infection during antituberculous therapy. Both hydrocephalus and tuberculomata should be looked for if any patient develops new neurological signs or symptoms during treatment of tuberculous meningitis.
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We studied the usefulness of serum ferritin for the assessment of iron deficiency (ID) or ID anaemia (IDA) of 186 lactating and 27 non-lactating Zairean women (15-45 years old). Haemoglobin (Hb), serum iron (SI), total iron binding capacity (TIBC), and transferrin saturation (TS) were also measured. Participants were recruited in rural Bas-Zaire State in the summers of 1986 and 1989. ⋯ ID defined by TS < 16% was present in 41% of lactating women and 21% of non-lactating women. In the presence as well as absence of inflammation, the use of TS identified a higher percentage of lactating women with either ID or IDA than did the use of serum ferritin. We conclude that, in the studied population, unless inflammation is taken into consideration, serum ferritin has a limited value in the diagnosis of ID.