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Migowa AN, Hamdi W, Hashad S, Etayari H, Abushhaiwia A, Ferjani H, Nessib DB, Kharrat L, Fazaa A, Owino L, Faleye A, Owusu SA, Mosa DM, Eissa M, Nasef SI, Elsehrawy GG, Odhiambo R, Orwa J, Abu-Zaid MH. Development of the paediatric society of the African league against rheumatism (PAFLAR) JIA registry and clinical profile of JIA in Africa from the PAFLAR JIA registry. Pediatr Rheumatol Online J 2024; 22:67. [PMID: 39039515 PMCID: PMC11264440 DOI: 10.1186/s12969-024-01000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The spectrum of Juvenile Idiopathic Arthritis (JIA) in Africa is still largely unknown. We thus set out to illustrate how we set up the PAFLAR JIA registry and describe the clinical profile of Juvenile Idiopathic Arthritis across various regions in Africa. METHODS We carried out a retrospective observational cohort study where collaborators were trained on use of the existing PAFLAR REDCAP database to enter data for the JIA patients currently under their care capturing their epidemiological data, clinical features, laboratory investigations, diagnosis and therapy at initial diagnosis. Descriptive statistics including means, standard deviations, medians, interquartile ranges (IQR) for continuous variables and proportions for categorical variables were calculated as appropriate. Tests for difference between groups were performed between categorical variables using Pearson's chi-square or Fisher's exact tests. All analyses were performed using SPSS version 22 software. RESULTS We enrolled 302 patients, 58.6% (177 of 302) of whom were female. The median age of disease onset was 7 years (range 3-11 years) and the median age at diagnosis was 8.5 years (range 5-12 years). The median duration delay in diagnosis was 6 months (range 1-20.8 months). The JIA categories included Systemic JIA 18.9% (57), Oligoarticular JIA 19.2% (83), Polyarticular RF + ve 5% (15), Polyarticular RF-ve 17.9% (54), Enthesitis Related Arthritis (ERA) 18.2% (55), Psoriatic Arthritis 7% (21) and undifferentiated JIA 5.6% (17). As regards treatment the commonest therapies were NSAID therapy at 31.1%, synthetic DMARDs at 18.1%, synthetic DMARDs combined with NSAIDs at 17.5% and steroid therapy at 9.6%. Biological DMARDs accounted for 2.3% of therapies offered to our patients at diagnosis. The average JADAS score was 10.3 (range 4.8-18.2) and the average CHAQ score was 1.3 (range 0.7-2.0). CONCLUSION Our study highlights strategies involved in setting up a Pan-African paediatric rheumatology registry that embraces our broad diversity and the vast spectrum of JIA in Africa while comparing the various therapies available to our patients. The PAFLAR JIA registry strives to ensure a comprehensive representation of the diverse healthcare landscapes within the continent. Further longitudinal observation studies are required to ascertain the long-term outcomes of our patients and ultimately help inform policy to create a more favorable health ecosystem to support the healthcare needs of JIA patients in Africa.
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Affiliation(s)
- Angela Nyangore Migowa
- Department of Paediatrics, Aga Khan University Medical College East Africa Nairobi, P.O Box 30270, Nairobi, 00100, Kenya.
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Institute - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Soad Hashad
- Tripoli Children's Hospital, University of Tripoli, Tripoli, Libya
| | - Hala Etayari
- Tripoli Children's Hospital, University of Tripoli, Tripoli, Libya
| | | | - Hanene Ferjani
- Rheumatology Department, Kassab Institute of Orthopedics, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Dorra Ben Nessib
- Department of Rheumatology, Kassab Institute - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Lobna Kharrat
- Department of Rheumatology, Kassab Institute - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Alia Fazaa
- Department of Rheumatology, Mongi Slim Hospital - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Lawrence Owino
- Department of Paediatrics, Faculty of Health Sciences Nairobi, University of Nairobi, Nairobi, Kenya
| | - Ayodele Faleye
- Department of Paediatrics, Lagos State University Teaching Hospital Lagos, Lagos, Nigeria
| | - Sheila Agyeiwaa Owusu
- Department of Paediatrics and Child Health, University for Development Studies, Tamale, Ghana
| | - Doaa Mosad Mosa
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Mervat Eissa
- Department of Rheumatology, Cairo University, Cairo, Egypt
| | | | | | - Rachel Odhiambo
- Research Unit, Aga Khan University Medical College East Africa Nairobi, Nairobi, Kenya
| | - James Orwa
- Department of Population Health, Aga Khan University Medical College East Africa Nairobi, Nairobi, Kenya
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Jiang Y, Rudin RS, Solomon DH. Clinical Visit Frequencies in Rheumatology: A Systematic Literature Review. Arthritis Care Res (Hoboken) 2023; 75:2054-2062. [PMID: 36807719 PMCID: PMC10440366 DOI: 10.1002/acr.25106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Clinical visits are a fundamental aspect of rheumatic disease care, but recommendations for appropriate visit frequencies are largely absent from guidelines, scarcely studied, and inconsistently reported. The aim of this systematic review was to summarize the evidence pertaining to visit frequencies for major rheumatic diseases. METHODS This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Title/abstract screening, full-text screening, and extraction were carried out by 2 independent authors. Annual visit frequencies were either extracted or calculated and stratified by disease type and country of study. Weighted mean annual visit frequencies were calculated. RESULTS A total of 273 relevant manuscript records were screened, and 28 were included after applying selection criteria. The included studies were equally divided between US and non-US and were published between 1985 and 2021. Most (n = 16) focused on rheumatoid arthritis (RA), systemic lupus erythematosus (SLE; n = 5), and fibromyalgia (FM; n = 4). For RA, the average annual visit frequencies were 5.25 for US rheumatologists, 4.80 for US non-rheumatologists, 3.29 for non-US rheumatologists, and 2.74 for non-US non-rheumatologists. For SLE, annual visit frequencies for non-rheumatologists were much higher than for US rheumatologists (12.3 versus 3.24). For FM, annual visit frequencies were 1.80 for US rheumatologists and 0.40 for non-US rheumatologists. There was a decreasing trend of visit frequency to rheumatologists from 1982 to 2019. CONCLUSION Evidence for rheumatology clinical visits was limited and heterogeneous on a global scale. However, general trends suggest more frequent visits in the US and less frequent visits in recent years.
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Affiliation(s)
| | | | - Daniel H Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Fernández-Ávila DG, Patino-Hernandez D, Kowalskii S, Vargas-Caselles A, Sapag AM, Cachafeiro-Vilar A, Meléndez B, Santiago-Pastelín C, Graf C, Rossetto C, Palleiro D, Trincado D, Fernández-Ávila DC, Arrieta D, Reyes G, Baez JT, Ugarte-Gil MF, Cardiel M, Colman N, Chávez N, Burgos PI, Montufar R, Sandino S, Fuentes-Silva Y, Soriano ER. Rheumatology Training in Latin America: A Collaborative Study by the Pan American League of Associations for Rheumatology. J Clin Rheumatol 2022; 28:e440-e443. [PMID: 34348368 DOI: 10.1097/rhu.0000000000001774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Demand for rheumatology care has steadily increased in recent years. The number of specialists in this field, however, seems insufficient. No recent studies have diagnosed the attributes of rheumatology training in Latin America. METHODS This is a descriptive cross-sectional study. We obtained data on each country through local rheumatologists of the Pan-American League Against Rheumatism, who acted as principal investigators for participating countries. Our sample was analyzed and described through means and standard deviations or through frequencies and percentages, depending on the variable. RESULTS Countries with the most rheumatology-training programs were Brazil (n = 50), Argentina (n = 18), and Mexico (n = 15). Ecuador, Honduras, and Nicaragua do not have rheumatology-training programs. The countries with the most available slots for rheumatology residents were Brazil (n = 126) and Argentina (n = 36). To be admitted into rheumatology training, candidates were required to have completed graduate studies in internal medicine in 42.1% of the programs. In 8 countries (42.1%), residents are not required to pay tuition; the median cost of tuition in the remaining countries is US $528 (interquartile range, US $2153). CONCLUSIONS Conditions associated with rheumatology training in Latin America vary. Significant differences exist in income and tuition fees for residents, for example, and 4 countries in Latin America do not currently offer programs. Information collected in this study will be useful when comparing the status of rheumatology services offered in Latin America with those in other countries. Most countries require a wider offering of rheumatology-training programs, as well as more available slots.
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Affiliation(s)
- Daniel G Fernández-Ávila
- From the Unidad de Reumatología, Hospital Universitario San Ignacio-Facultad de Medicina, Pontificia Universidad Javeriana, Unidad de Investigación PANLAR
| | - Daniela Patino-Hernandez
- Departamento de Medicina Interna, Hospital Universitario San Ignacio-Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Kowalskii
- Universidade Federal do Paraná, Unidad de Investigación PANLAR, Paraná, Brasil
| | | | | | | | - Belia Meléndez
- Hospital de la Policía Nacional N1 Quito, Quito, Ecuador
| | | | - Cesar Graf
- Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | | | - Daniel Palleiro
- Instituto Nacional de Reumatología del Uruguay-Universidad de la República, Montevideo, Uruguay
| | - Daniela Trincado
- Pontificia Universidad Católica de Chile, Departamento de Inmunología Clínica y Reumatología, Santiago de Chile, Chile
| | | | - Dina Arrieta
- Hospital México, Caja Costarricense del Seguro Social, San José de Costa Rica, Costa Rica
| | - Gil Reyes
- Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | | | - Manuel F Ugarte-Gil
- Hospital Guillermo Almenara Irigoyen-Universidad Científica del Sur, Lima, Perú
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, México
| | - Nelly Colman
- Hospital de Clínicas-Universidad Nacional de Asunción, Asunción, Paraguay
| | - Nilmo Chávez
- Universidad San Carlos de Guatemala-Instituto Guatemalteco de Seguridad Social, Ciudad de Guatemala, Guatemala
| | - Paula I Burgos
- Pontificia Universidad Católica de Chile, Departamento de Inmunología Clínica y Reumatología, Santiago de Chile, Chile
| | - Ruben Montufar
- Consultorio de Especialidades del Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
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Tangcheewinsirikul S, Tang SP, Smith N, Sukharomana M, Charuvanij S, Vilaiyuk S, Arkachaisri T, Scott C, Foster HE. Delivery of paediatric rheumatology care: a survey of current clinical practice in Southeast Asia and Asia-Pacific regions. Pediatr Rheumatol Online J 2021; 19:11. [PMID: 33485337 PMCID: PMC7824936 DOI: 10.1186/s12969-021-00498-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Paediatric rheumatic diseases are a leading cause of acquired disability in Southeast Asia and Asia-Pacific Countries (SE ASIA/ASIAPAC). The aims of this study were to identify and describe the challenges to the delivery of patient care and identify solutions to raise awareness about paediatric rheumatic diseases. METHODS The anonymised online survey included 27 items about paediatric rheumatology (PR) clinical care and training programmes. The survey was piloted and then distributed via Survey-Monkey™ between March and July 2019. It was sent to existing group lists of physicians and allied health professionals (AHPs), who were involved in the care pathways and management of children with rheumatic diseases in SE ASIA/ASIAPAC. RESULTS Of 340 participants from 14 countries, 261 participants had been involved in PR care. The majority of the participants were general paediatricians. The main reported barriers to providing specialised multidisciplinary service were the absence or inadequacy of the provision of specialists and AHPs in addition to financial issues. Access to medicines was variable and financial constraints cited as the major obstacle to accessing biological drugs within clinical settings. The lack of a critical mass of specialist paediatric rheumatologists was the main perceived barrier to PR training. CONCLUSIONS There are multiple challenges to PR services in SE ASIA/ASIAPAC countries. There is need for more specialist multidisciplinary services and greater access to medicines and biological therapies. The lack of specialist paediatric rheumatologists is the main barrier for greater access to PR training.
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Affiliation(s)
- Sirikarn Tangcheewinsirikul
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Swee-Ping Tang
- grid.413442.40000 0004 1802 4561Paediatric Rheumatology Unit, Selayang Hospital, Selangor, Malaysia
| | - Nicola Smith
- grid.1006.70000 0001 0462 7212Paediatric Rheumatology, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Maynart Sukharomana
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Soamarat Vilaiyuk
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thaschawee Arkachaisri
- grid.414963.d0000 0000 8958 3388Department of Paediatric Subspecialties, Rheumatology and Immunology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Christiaan Scott
- grid.415742.10000 0001 2296 3850Division of Paediatric Rheumatology, Department of Paediatrics, University of Cape Town, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Paediatric Rheumatology, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK ,grid.472342.40000 0004 0367 3753Newcastle University Medicine Malaysia, Johor, Malaysia
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Fernández-Ávila DG, Patino-Hernandez D, Kowalskii S, Vargas-Caselles A, Sapag AM, Cachafeiro-Vilar A, Meléndez-Muñoz L, Santiago-Pastelín C, Graf C, Rossetto C, Palleiro D, Trincado D, Fernández-Ávila D, Arrieta D, Reyes G, Then Baez J, Ugarte-Gil MF, Cardiel M, Colman N, Chávez N, Burgos PI, Montúfar R, Sandino S, Fuentes-Silva Y, Soriano ER. Current status of the rheumatologists' workforce in Latin America: a PANLAR collaborative study. Clin Rheumatol 2021; 40:2913-2920. [PMID: 33449230 DOI: 10.1007/s10067-020-05555-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/06/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Studies conducted by various scientific societies have shown that the demand for specialized rheumatology care is greater than the projected growth of the workforce. Our research aims to assess the current status of the rheumatology workforce in Latin America. METHOD This is a descriptive, cross-sectional study. A survey was created on the RedCap platform. Data were analyzed with STATA 15® Software. We present descriptive analyses. The rate of inhabitants per rheumatologist was calculated using the number of rheumatologists practicing in each country and the inhabitants for year 2020. RESULTS Our sample was composed by 19 PANLAR member countries in Latin America. Latin America has one rheumatologist per 106,838 inhabitants. The highest rate of rheumatologist per inhabitants was found in Uruguay (1 per 27,426 inhabitants), and the lowest was found in Nicaragua (1 per 640,648 inhabitants). Mean age was 51.59 (SD12.70), ranging between 28 and 96 years of age. Mean monthly compensation was USD $2382.6 (SD$1462.5). The country with lowest salary was Venezuela ($197), whereas the highest was Costa Rica ($4500). CONCLUSIONS There is a high variability in rheumatologists' workforce characteristics in Latin America. These results could lead to policies aiming to increase the availability and income of rheumatologists, in order to increase opportunity and quality of care of patients living with rheumatic diseases. Key Points • The rheumatologists' workforce varies significantly among Latin American countries. • The supply of rheumatologists is insufficient for meeting the increasing need for specialists in this field.
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Affiliation(s)
- Daniel Gerardo Fernández-Ávila
- Unidad de Reumatología, Hospital Universitario San Ignacio - Facultad de Medicina, Pontificia Universidad Javeriana, Unidad de Investigación PANLAR, Cra 7 # 40-62, Bogotá, Colombia.
| | - Daniela Patino-Hernandez
- Departamento de Medicina Interna, Hospital Universitario San Ignacio - Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Kowalskii
- Universidade Federal do Paraná, Unidad de Inivestigación PANLAR, Paraná, Brazil
| | | | | | | | | | | | - Cesar Graf
- Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | | | - Daniel Palleiro
- Instituto Nacional de Reumatología del Uruguay - Universidad de la República, Montevideo, Uruguay
| | - Daniela Trincado
- Departamento de Inmunología Clínica y Reumatología, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | | | - Dina Arrieta
- Hospital México, Caja Costarricense del Seguro Social, San José de Costa Rica, Costa Rica
| | - Gil Reyes
- Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | | | - Manuel F Ugarte-Gil
- Universidad Científica del Sur - Hospital Guillermo Almenara Irigoyen, Lima, Peru
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Mexico
| | - Nelly Colman
- Hospital de Clínicas - Universidad Nacional de Asunción, Asunción, Paraguay
| | - Nilmo Chávez
- Universidad San Carlos de Guatemala - Instituto Guatemalteco de Seguridad Social, Guatemala City, Guatemala
| | - Paula I Burgos
- Pontificia Universidad Católica de Chile, Dto de Inmunologia Clínica y Reumatología, Santiago de Chile, Chile
| | - Ruben Montúfar
- Consultorio de Especialidades del Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
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Oliver S, Tam LS, Suet-Kei Kwok G, Fusama M, Nakahara H, Zhang CY, Yamamoto K, Furtner D. The Asia-Pacific Initiative for Rheumatology Nurse Education: Current gaps, programme development and future outlook. Musculoskeletal Care 2020; 18:397-403. [PMID: 32302046 DOI: 10.1002/msc.1473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Susan Oliver
- Rheumatology Nurse Consultant, Susan Oliver Associates, Barnstaple, Devon, UK
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | | | - Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Sciences, Osaka, Japan
| | - Chun-Yan Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Kazuhiko Yamamoto
- Center for Integration Medical Sciences, RIKEN Yokohama Institute, Yokohama, Japan
| | - Daniel Furtner
- Janssen, a Division of Johnson & Johnson Private Limited, Singapore
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Sung YH, Park JM. [A case of malarial hepatitis by Plasmodium vivax]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 56:329-33. [PMID: 21099242 DOI: 10.4166/kjg.2010.56.5.329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Malarial infection is one of the most important tropical diseases, but also increasing in the temperate regions. Severe malaria with organ dysfunction is commonly associated with Plasmodium falciparum, but rarely with Plasmodium vivax. Malarial hepatitis is also unusual in P. falciparum and very rare in P. vivax. Only 3 cases of malarial hepatitis caused by P. vivax have been reported in the world. Because the presence of hepatitis in malaria indicates a more severe illness with higher incidence of other complications and poor prognosis, malarial patients should be meticulously monitored for hepatic dysfunction with or without jaundice. We report here a case of malarial hepatitis caused by P. vivax that was presented by fever, general ache, nausea, fatigue, and significant elevation of aminotransferase and bilirubin.
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Affiliation(s)
- Young Ho Sung
- Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea.
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Lee SW, Lee J, Lee DY, Chun KA, Ahn BC, Kang YM, Lee K. Evaluation of hepatic function with 99mTc-galactosylated serum albumin scintigraphy in patients with malaria: Comparison with 99mTc-colloid scintigraphy and liver ultrasonography. Nucl Med Commun 2007; 28:95-9. [PMID: 17198349 DOI: 10.1097/mnm.0b013e328013eae3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Malarial parasites injected by the mosquito rapidly target hepatocytes, and hepatomegaly is commonly observed during the progress of the disease in malaria patients. To evaluate the degree of hepatic damage and functional status of hepatocytes in malaria patients, we performed liver scintigraphy using (99m)Tc-galactosylated serum albumin (GSA) prospectively and the findings were compared with those of (99m)Tc-colloid scintigraphy, ultrasonography and clinical results in the same subject. METHODS Eight malaria patients (all male, mean age 22 years) confirmed to be infected with Plasmodium vivax underwent (99m)Tc-GSA liver scintigraphy, followed by liver ultrasonography and (99m)Tc-colloid scintigraphy using phytate within 3 days. For hepatocyte scintigraphy, anterior images of cardiac blood-pool and liver were continuously acquired for 30 min after injection of 185 MBq (99m)Tc-GSA (3 mg). In addition to visual interpretation of the images, quantitative measurement of hepatic function was performed with several functional parameters, such as hepatic uptake index (LHL15), blood clearance index (HH15) and modified receptor index (LHL/HH) calculated from the radioactivity of the liver and heart. (99m)Tc-colloid images were assessed and graded visually. Severity of hepatic dysfunction or reticuloendothelial system activation was classified as normal, mild, moderate and severe on GSA or colloid images. RESULTS Hepatomegaly was observed in five and splenomegaly in seven of the eight patients. Serum levels of transaminase and alkaline phosphatase were mildly elevated in two. Visual assessment of GSA scintigraphy revealed normal findings in all subjects, except for mild increases in size. The mean values of LHL15, HH15 and LHL/HH were 0.928+/-0.014, 0.537+/-0.031 and 1.732+/-0.106, respectively. They were graded as normal in five, and near-normal to mild dysfunction in three subjects. In contrast, (99m)Tc-colloid scintigraphy revealed abnormal findings in all of the subjects, and graded as moderate in three or severe reticuloendothelial system activation in five subjects. Liver ultrasonographic findings were normal for all subjects except mild hepatomegaly. CONCLUSIONS Malaria-induced injury of the hepatocyte is likely to be minimal whereas hepatomegaly is commonly seen during disease process. This suggests that hepatic damage in malarial infection is mainly due to involvement of the reticuloendothelial system. (99m)Tc-GSA scintigraphy can be used in differentiating hepatocellular damage from reticuloendothelial system involvement in patients with infectious disease showing hepatomegaly.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Korea
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Yi KJ, Chung MH, Kim HS, Kim CS, Pai SH. A relapsed case of imported tertian malaria after a standard course of hydroxychloroquine and primaquine therapy. THE KOREAN JOURNAL OF PARASITOLOGY 1998; 36:143-6. [PMID: 9637832 DOI: 10.3347/kjp.1998.36.2.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Resistance of Plasmodium species to antimalarial agents has become increasingly challenging to the management and prevention of malaria. We experienced an imported case of tertian malaria due to Plasmodium vivax relapsed after a seemingly successful treatment with conventional course of hydroxychloroquine and primaquine. A 35-year-old man developed fever three days after return from India and mainland China. After his illness was diagnosed as tertian malaria, he was managed with hydroxychloroquine and then primaquine (primaquine base 15 mg/day for 14 days). Thereafter peripheral blood smears showed no malarial parasites, and there was no relapse of symptom until the 55th post-treatment day, however, six months after the above treatment tertian malaria relapsed. He was managed with the same medications again and malaria did not relapse for 10 months.
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Affiliation(s)
- K J Yi
- Department of Internal Medicine, Inha University, Medical College, Korea
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Joo CY, Kang GT. Epidemio-entomological survey on malarial vector mosquitoes in Kyongbuk, Korea. THE KOREAN JOURNAL OF PARASITOLOGY 1993; 30:329-40. [PMID: 1363628 DOI: 10.3347/kjp.1992.30.4.329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In order to determine population dynamics of Anopheles sinensis, a survey based on average number of female mosquitoes per trap-night was carried out during the period of 5 years from 1987 to 1991. A. sinensis first appeared between the 2nd and 20th April, and were trapped in large number between the 5th and 12th July. The number of trapped mosquitoes began to decrease from mid-August, and a few were collected until mid-November, each year. The average number of A. sinensis in July was 542.6 per trap-night in 1987, but in 1989 increased abruptly to 1,331.4, and then decreased to considerably lower levels, 271.9 in 1990 and 372.1 in 1991. The nocturnal activity of A. sinensis to attack humans was found to become active in the early night, and it was gradually decreasing at mid-night, however, then slightly increasing toward dawn. The immature stage of A. sinensis in the rice paddies was first found in the correlation pattern with peak adult densities in early July. The highest larval density of A. sinensis in the study area was 21,226 x 10(3) in early July 1990. The larval A. sinensis showed high resistance level and resistance ratios against 3 kinds of organo-phosphorous compounds, diazinon, malathion, and fenitrothion, but low resistance against fenthion. The present results indicated that the population density of A. sinensis in Kyongbuk area is decreasing over the five-year from 1987 to 1991.
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Affiliation(s)
- C Y Joo
- Department of Parasitology, School of Medicine, Keimyung University, Taegu, Korea
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