Hipoglikemia pada Seorang Penderita Malaria

Hypoglycemia is a serious and often fatal complication of severe malaria. This condition has been reported in many parts of the world including from Thailand (1983) and from Indonesia by Hoffman (1988) and Harianto (1990). Two main causes that can lead to development of this condition are quinine administration and the severity of the malaria condition itself. A case study is presented about development of prolonged hypoglycemia after quinine administration. A 41 years old male was hospitalized with 4 days history of fever, headache vomiting and icterus. On examination he was found to be in good mental status, had a normal blood pressure, and a body temperature of 40°C. He also had icterus and hepatomegaly. Laboratory examination on admission showed malaria slide positive forRfalciparum ring 30-40, with parasite count of 3% (+) on day I. CBC showed: WBC of 21,700/mm3 and platelet count of 40,000/mm3. Blood chemistry showed glucose level of 77 mm %, serum bilirubin of 29.34 mg % (direct 21.87 mg %) SGOT 31 u/l, SGPT 20 u/l, serum ureum 167 mg %, creatinine of 3.36 mg %, serum Na 123 m Eq/L and K 3.99 Eq/L. Urinalysis was normal except for specific gravity of 1.07. After diagnosis of bilious malaria was confirmed, the patient was given i.v. quinine 500 mg diluted in 500 ml 5% dextrose, infused over 4 hours and repeated every 8 hours. On day IVi.v. quinine was switched to oral preparation of 600 mg given bid and the next day quinine was changed to oral chloroquine. The day after admission (30 hours after quinine administration), blood glucose dropped to 21 mg %, 16-46 mg % on day III, and to less than 10 mg % on day IV. It gradulty returned to normal afterwards. Administration of 10% dextrose and boluses of 40% glucose were able to keep the patient in good clinical condition and prevent death. Malaria slide improved on day III, became negative by day IV and serum bilirubin also decreased on follow up. Hypoglycemia should be expected in severe malaria and intensive management of this condition could prevent death

Presentasi Klinik, Komplikasi dan Mortaliti Malaria Serebral di RS Bethesda, Minahasa

A retrospective study of cerebral malaria was performed in the Department of Internal Medicine, Bethesda Hospital - Tomohon, North Sulawesi, from January 1983 until October 1989. Among 2261 cases of malaria admitted in this hospital, there were 72 cases of cerebral malaria. The proportion of cerebral malaria cases increased from 0.8 % in 1983 to 6.4% in 1989. The mortality increased in the last 2 years, in spite of the same protocol-therapy in Bethesda Hospital. The total mortality was 30.5 %. There were 37 men and 35 women with an age distribution of 13-79 years. Parasitemia of more than 2 % occurs in 18 % and less than 2 % in 82 %. Complications were anemia 34%; hypoglycemia 9 %; creatinine 2 mg % in 36 %; hyponatremia 92 % and hyperbilirubenemia in 50 %. Several factors influencing the mortality were : Hypoglycemia less than 50 mg %Decreased conciousness level to sopor and comaCreatinine more than 2 mg %Total bilirubine more than 2 mg %More than one organ involvement for complications.Delayed and insufficient treatment.Probable resistence to treatment (quinine or chloroquine) It is not certain which factors have a dominant role in mortality but in a condition with more than one factor the mortality was very high

HIPOGLIKEMIA PADA SEORANG PENDERITA MALARIA

Hypoglycemia is a serious and often fatal complication of severe malaria. This condition has been reported in many parts of the world including from Thailand (1983) and from Indonesia by Hoffman (1988) and Harianto (1990). Two main causes that can lead to development of this condition are quinine administration and the severity of the malaria condition itself. A case study is presented about development of prolonged hypoglycemia after quinine administration. A 41 years old male was hospitalized with 4 days history of fever, headache vomiting and icterus. On examination he was found to be in good mental status, had a normal blood pressure, and a body temperature of 40°C. He also had icterus and hepatomegaly. Laboratory examination on admission showed malaria slide positive forRfalciparum ring 30-40, with parasite count of 3% (+) on day I. CBC showed: WBC of 21,700/mm3 and platelet count of 40,000/mm3. Blood chemistry showed glucose level of 77 mm %, serum bilirubin of 29.34 mg % (direct 21.87 mg %) SGOT 31 u/l, SGPT 20 u/l, serum ureum 167 mg %, creatinine of 3.36 mg %, serum Na 123 m Eq/L and K 3.99 Eq/L. Urinalysis was normal except for specific gravity of 1.07. After diagnosis of bilious malaria was confirmed, the patient was given i.v. quinine 500 mg diluted in 500 ml 5% dextrose, infused over 4 hours and repeated every 8 hours. On day IVi.v. quinine was switched to oral preparation of 600 mg given bid and the next day quinine was changed to oral chloroquine. The day after admission (30 hours after quinine administration), blood glucose dropped to 21 mg %, 16-46 mg % on day III, and to less than 10 mg % on day IV. It gradulty returned to normal afterwards. Administration of 10% dextrose and boluses of 40% glucose were able to keep the patient in good clinical condition and prevent death. Malaria slide improved on day III, became negative by day IV and serum bilirubin also decreased on follow up. Hypoglycemia should be expected in severe malaria and intensive management of this condition could prevent death

Clinical Efficacy and Laboratory Improvement of Bacillus Calmette-Guerin Vaccination on Adult Atopic Asthma

Background Recent studies have shown that Bacillus Calmette-Guerin (BCG) vaccination is inversely related to asthma, a Th2 cell-associated with allergic disease, which BCG in humans induces Th1-cell immune responses and prevents airway remodeling.Objective To investigate whether thrice BCG vaccinations are clinically effective and could induce laboratory improvement compared with placebo on phase 1 (12 weeks) and single BCG vaccination on phase 2 of the study, then finding out whether the effect might last until 9 months after thrice vaccination and 9 months after single vaccination on adult atopic extrinsic asthma.Methods According to the Global Initiative for Asthma criteria, 40 mild to moderate persistent atopic asthma patients were randomly assigned in a double-blind fashion into groups that received intra-dermal injection of 0.1 mL of BCG (n = 20) or 0.1 mL of placebo (n = 20) on the first day. On the first phase, subjects on BCG vaccinations were given intradermal injections 3 times on the deltoid region every 4 weeks. On the second phase, at the 12th week, the placebo group was given BCG vaccination once, and this group became the single BCG group. The symptom score (SS) and drug score (DS), lung function, eosinophil blood count (EBC), total serum immunoglobulin E, interferon-γ (IFN-γ), interleukin 4, and transforming growth factor-β1 (TGF-β1) were examined on the first phase (before the treatment and at the 12th week) and on the second phase (on the sixth and ninth months after the third vaccination for thrice BCG group or after single BCG for control group) to monitor the efficacy.Results There were some improvements of asthma SS (P 0.05), IFN-γ (P < 0.05), and TGF-β1 (P < 0.05) on thrice BCG group compared with prevaccination and with placebo on the first phase and second phase of the study compared with single BCG (formerly placebo).Conclusions Based on the previous findings, we could confirm that thrice BCG vaccinations proved to be better than the placebo group and single vaccination. The efficacy of thrice BCG vaccinations on asthma was detected by the improvement of SS, DS, forced expiratory volume in 1 second, peak expiratory flow rate, EBC, IFN-γ, and TGF-β1 until 9 months from the last vaccination without any side effects. Keywords: BCG, symptom/drug score, IFN-γ, IL-4, TGF-β1, adult, atopy, asthm

Effect of Nigella sativa

This study was aimed to quantify the antihyperglycemic effect of Nigella sativa (N. sativa). An in-depth search to identify clinical trials investigating the impact of N. sativa on glycemic indices via MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google scholar databases were performed up to November 2018. We used a random effects model to estimate pooled effect size of fasting plasma glucose (FPG), postprandial blood glucose (PPBG), and hemoglobin A1c (HbA1c). A total of 17 randomized controlled trials investigating the effects of N. sativa on FPG, PPBG, and HbA1c were included. Meta-analysis suggested a significant association between N. sativa supplementation and reduction in FPG (weighted mean difference WMD: -9.93 mg/dl, 95% CI -13.44, -6.41), PPBG (WMD: -14.79 mg/dl, 95% CI -24.19, -5.39), and HbA1c (WMD: -0.57%, 95% CI -0.77, -0.37). Subgroup analysis revealed that N. sativa oil was more effective than N. sativa powder in reduction of FPG. To sum up, N. sativa consumption has a significant lowering effect on glycemic status. Further studies with prolonged durations and powerful design are needed to specify the exact mechanism, optimal dosage, and duration of N. sativa supplementation to obtain a beneficial effect on glycemic status