Place: Bellary
Date:
From,
Dr. HUGGI VISWANATHA
Post Graduate Student in M.D.
Dept. of Medicine,
VIMS, Bellary.
To,
The Principal,
Vijayanagar Institute Of Medical Sciences,
Bellary.
THROUGH PROPER CHANNEL
Respected sir,
Subject: Acceptance of registration and forwarding of dissertation topic,
In accordance with the above cited subject, I undersigned studying Post Graduate Course in M.D. General Medicine have been allottedfollowing dissertation topic“A STUDY OF CLINICAL PROFILE, COMPLICATIONS AND DIAGNOSIS IN 100 CASES OF MALARIA ADMITTED IN VIMS BELLARY WITH SPECIAL REFFERENCE TO COMPARISION OF VARIOUS MODALITIES OF DIAGNOSIS ”, under the guidance of Dr .S.L. RAVI,Professor,Department of Medicine, VIMS, Bellary.
I request you to kindly forward the dissertation topic in the prescribed form to the university for approval.
Thanking you,
Yours faithfully,
DR.HUGGI VISWANATHA
Signature of the guide Signature of co-guide
Dr. S.L. RAVI Dr.MARIRAJ.J.
Professor, Professor,
Department of Medicine, Dept of Microbiology
VIMS, Bellary. VIMS , Bellary
Place: Bellary
Date:
From,
The Professor & Head of the Department,
Department of Medicine,
VIMS, Bellary.
To,
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore.
THROUGH PROPER CHANNEL
Respected sir,
As per the regulations of the University of registration of Dissertation topic, the following Post Graduate in M.D. General Medicine has been allotted the dissertation topic as by the Official Registration Committee of all qualified and eligible guides of the Department of Medicine.
NAME / TOPIC / GUIDEDr. HUGGI VISWANATHA
Post Graduate Student in M.D.
Dept. of Medicine,
VIMS, Bellary. / “A STUDY OF CLINICAL PROFILE, COMPLICATIONS AND DIAGNOSIS IN 100 CASES OF MALARIA ADMITTED IN VIMS BELLARY WITH SPECIAL REFFERENCE TO COMPARISION OF VARIOUS MODALITIES OF DIAGNOSIS ” / Dr.S.L.RAVI
Professor,
Department of Medicine,VIMS, Bellary
Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking you,
Yours faithfully,
DR.GADWALKAR R SRIKANT
Professor & Head of the Department,
Department of Medicine,
VIMS, Bellary.
Signature of the guide
Dr.S.L.RAVI
Professor,
Department of Medicine,
VIMS, Bellary.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE—II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS (in block letters) / Dr. HUGGI VISWANATHAPOST GRADUATE STUDENT IN M.D.GENERAL MEDICINE. VIMS,BELLARY-583 104
2. / NAME OF THE INSTITUTION / VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY
3. / COURSE OF STUDY AND SUBJECT / MD GENERAL MEDICINE
4. / DATE OF ADMISSION TO THE COURSE / 02-05-2009
5. / TITLE OF THE TOPIC:
“A STUDY OF CLINICAL PROFILE, COMPLICATIONS AND DIAGNOSIS IN 100 CASES OF MALARIA ADMITTED IN VIMS BELLARY WITH SPECIAL REFFERENCE TO COMPARISION OF VARIOUS MODALITIES OF DIAGNOSIS ”
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Malaria is a major vector-borne disease in India.India had an estimated 10.6 million malaria cases in 2006 that account for approximately 60% of cases in the WHO South-East Asia Region.
Karnataka is 3rd most affected state in india.Malaria in India was responsible for economic loss between US $ 0.5 to 1.0 billion annually.Malaria is endemic in Bellary,with increased incidence of falciparum malaria.We are frequently encountering cerebral malaria cases mainly because of delay in diagnosis.
Confirmation of malaria by laboratory methods presents a diagnostic challenge, hence this study will emphasize on importance of various modalities of diagnosis.
6.2 REVIEW OF LITERATURE:
Malaria is the most common parasitic disease of man. Malaria is
currently endemic in 109 countries and in territories of tropical and subtropical zones, spanning all continents of the world except Antarctica and Australia.There were an estimated 247 million malaria cases among 3.3 billion peopleat risk in 2006, causing nearly million deaths1.
Malaria is a protozoan disease transmitted by the bite of infected Anopheles mosquitoes. It is the most important of the parasitic diseases of humans, with transmission in 107 countries containing 3 billion people and causing 1–3 million deaths each year.Malaria has now been eliminated from the United States, Canada, Europe, and Russia but, despite enormous control efforts, has resurged in many parts of the tropics. Added to this resurgence are the increasing problems of drug resistance of the parasite and insecticide resistance of the vectors. Occasional local transmission after importation of malaria has occurred recently in several southern and eastern areas of the United States and in Europe, indicating the continual danger to nonmalarious countries. Although there are promising new control and research initiatives, malaria remains today, as it has been for centuries, a heavy burden on tropical communities, a threat to nonendemic countries, and a danger to travelers2.
The geographical position and climate of India is favourable for the transmission of malarial infection. The maximum prevalence of malaria in most parts of India is from July to November months. The temperature between 20-30°C is favourable to the parasite and humidity of more than 60% is favourable for the longevity, activity
and by the mosquitoes. Rainfall provides mosquitoes, a breeding ground giving rise to epidemics whereas heavy rains washes out these breeding places. Summers may paradoxically lead to favourable conditions for transmission by creation of small pools of stagnant water4,5.
Malaria is a very common cause of fever in tropical countries. The first symptoms of malaria are nonspecific; the lack of a sense of well-being, headache, fatigue, abdominal discomfort, and muscle aches followed by fever. In some instances, a prominence of headache, chest pain, abdominal pain, arthralgia, myalgia, or diarrhea may suggest another diagnosis.2
Although headache may be severe in malaria, there is no neck stiffness or photophobia resembling that in meningitis. While myalgia may be prominent, it is not usually as severe as in dengue fever, and the muscles are not tender as in leptospirosis or typhus. Nausea, vomiting, and orthostatic hypotension are common.2
The classic malarial paroxysms, in which fever spikes, chills, and rigors occur at regular intervals, are relatively unusual and suggest
infection with P. vivax or P. ovale. The fever is irregular at first (thatof falciparum malaria may never become regular); the temperature of nonimmune individuals and children often rises above 40°C in conjunction with tachycardia and sometimes delirium. Although childhood febrile convulsions may occur with any of the malarias, generalized seizures are specifically associated with falciparum malaria and may herald the development of cerebral disease2.
Anemia is one of the most important complications of malaria in children living in endemic. It is also major cause of morbidity in adults with acute falciparum malaria3.
Malarial infection of the central nervous system often leads to a severe neurological syndrome termed cerebral malaria. This is a rapidly fatal disease characterized byhemiplegia, aphasia, hemianopia, cerebellar ataxia, and otherfocal neurological sign.Malarial infection of the central nervous system is anencephalopathy, which occurs in around 2% of patientsinfected with P. falciparum1 and characterized by unarousablecoma6,7.
Jaundice and renal failure are the most common systemic manifestations of malaria. Jaundice is mostly due to unconjugated
hyperbilirubinemia secondary to intravenous hemolysis8,9.
A rapid test for diagnosis of malaria based on acridine orange staining of centrifuged blood samples in a microhematocrit tube (QBC) was compared with thick and thin peripheral blood smears in 2274 samples. Malaria was diagnosed in 239 (10.5%) patients by Leishman's staining technique and QBC method. The QBC method allowed detection of an additional 89 (3.9%) cases11.
The use of rapid diagnostic tests (RDTs) for Plasmodium falciparum malaria resulted in improved adequate treatment and health outcomes without increased cost per patient. RDTs may represent a tool for improved management of patients with fever in peripheral health care settings10.
6.3 OBJECTIVES OF THE STUDY:
To study clinical spectrum of malaria and complications of malaria like cerebral malaria, hypoglycemia,anemia etc
To study the pathogenesis and management in preventing the mortality due to cerebral malaria.
To compare the diagnostic and prognostic utility of rapid test with conventional thick and thin films
7 MATERIALS AND METHODS
SOURCE OF DATA:
The study will be conducted in patients admitted in the Department of General Medicine of VIMS hospital Bellary and also patients referred from other departments of combined hospitals of VIMS, BELLARY during the period from 01/01/2010 to 31/12/2010.
METHOD OF COLLECTION OF DATA :
Our study is a clinical, prospective,observational and open study.
All the patients with MALARIA will be selected and subjected to detailed history, physical examination and systemic examination. Investigations like RBS, B.Urea, S.Creatinine ,complete hemogram,peripheral smear for malarial parasites, malaria antigen test,
quantitative buffy coat ,widal test. Special tests like prothrombin time, USG abdomen and liver function tests will be done where ever necessary. Patients will be followed up till the discharge or death of the patient.
The complete data is collected in a specially designed Case
Recording Form . The data collected will be transferred in to a Master Chart, which is then subjected for statistical analysis. Patients are selected with the following inclusion/exclusion criteria.
1)INCLUSION CRITERIA:
All the cases diagnosed to have malaria by clinically or microscopy or antigen/antibody detection or quantitative buffy coat and treated at the Department of Medicine in the age group of 15 yr and above were included.
2)EXCLUSION CRITERIA:
Patients <14 years are excluded
All the patients included in the study will be explained about the procedure in detail and issued Patient Information Sheet. Informed/written consent will be taken in each case . All investigations and interventions will be done under direct supervision and guidance of our guide.
SAMPLE SIZE AND DESIGN:
A total of 100 cases will be studied prospectively.
7.3DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO DESCRIBE BRIEFLY
YES, our study requires investigations like
1)RANDOM BLOOD SUGAR
2)BLOOD UREA
3)SERUM CREATININE
4) COMPLETE HAEMOGRAM
5)PERIPHERAL SMEAR FOR MALARIAL PARASITES
6)Pf/Pv ANTIGEN TEST- MALARIA ANTIGEN TEST
7) QUANTITATIVE BUFFY COAT
8)WIDAL TEST
9)antiDENGUE IgM ANTIBODIES
10)LIVER FUNCTION TESTS
11) CSF STUDY
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF
-Yes
8. / LIST OF REFERENCES:
- World malaria report; who/hpm/gmp/2008.
- Nicholas j. white, Joel g. Bremen chapter 203, in: Harrison principles of
- The anemia of plasmodium falciparum malaria Weatherall and Abdalla br med bull.1982; 38: 147-152
- Seasonal variations in incidence of severe and complicated malaria in central India . KT Madhavan, UN Jajoo, A Bhalla
- Park K. "Malaria" in Park's textbook of preventive and social medicine. 15th edition, Park K (Ed). Banarsidas Bhanot publishers, Jabalpur, ;ndia, 1997, 188-200.
- A Biswas*, PK Gangopadhyay**, D Guha***, T Roy****
- Dhamija RM, Banerjee AK, Venkataram S. Cerebral malaria.
(Editor). New Delhi. Churchill Livingstone, 1991;pp3-27.
- Acute Hepatitis in Malaria,Hatem Shoukier, MD Sandeep Dham, MD Nora V. Bergasa, MD , Downstate Medical Center, Brooklyn, NY
- Ghoda MK. Falciparum hepatopathy: a reversible and transient
2002;23:70-71
10. Msellem MI, Mårtensson A, Rotllant G, Bhattarai A, Strömberg J, et al.
(2009) Influence of Rapid Malaria Diagnostic Tests on Treatment and
Health Outcome in Fever Patients, Zanzibar—A Crossover Validation
Study. PLoS Med 6(4): e1000070. doi:10.1371/journal.pmed.1000070
11.M JW Pinto, SR Rodrigues, R Desouza, MP Verenkar
Department of Microbiology, Goa medical college, Bambolim, Goa – 403202,India
9. / SIGNATURE OF THE CANDIDATE: / (Dr. HUGGI VISWANATHA)
10. / REMARKS OF THE GUIDE:
11. / 11.1 NAME AND DESIGNATION OF GUIDE
(in block letters)
11.2 SIGNATURE
11.3 CO.GUIDE (if any)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT:
11.6 SIGNATURE / DR. S.L.RAVI
Professor,
Department of Medicine,
VIMS, Bellary.
DR .MARIRAJ.J.
Professor,
Dept Of Microbiology
VIMS, Bellary.
DR. GADWALKAR R SRIKANT
Prof. & Head Of The Department,
Department of Medicine,
VIMS, Bellary.
12. / 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2 SIGNATURE