1/13. Medical treatment of the adolescent drug abuser. An opportunity for rehabilitative intervention.Illnesses related to both the pharmacologic properties of abused substances and their methods of administration often bring the teenager to medical attention and may provide sufficient motivation for the adolescent to seek help beyond the acute problem. Successful treatment of an overdose reaction, an abstinence syndrome, or any other medical complication of drug abuse may give the physician a unique opportunity to begine further evalution for future care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Imported malaria in pregnancy: report of four cases and review of management.Malaria is a common infection worldwide. Increased travel by pregnant women makes it likely that physicians in the united states will see cases of malaria in this population. We observed four cases of malaria during pregnancy over an 8-month period at a general hospital in the united states. These cases illustrate the association between pregnancy and severe malaria in the mother and congenital infection in the newborn. We also noted delays in diagnosis because malaria was mistaken for other common illnesses. Therapy was complicated by concerns about the safety of antimalarial agents for the fetus and newborn as well as drug resistance. While chloroquine is safe for use in pregnancy, drug resistance is now common, especially when the etiologic organism is plasmodium falciparum. There are concerns about the safety of administering other antimalarial agents during pregnancy (e.g., mefloquine). Concerns about the safety and availability of these agents limit options for prophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. Malaria in travelers returning from short organized tours to holiday resorts in Mombassa, kenya.BACKGROUND: Short trips to holiday resorts in Mombassa, kenya, have gained popularity among Israelis since the early 1990s. A cluster of cases of malaria among returned travelers raised concern that preventive measures were being neglected. OBJECTIVES: To characterize the demographic and clinical features of malaria acquired in kenya, and to assess the adequacy of preventive measures. methods: Data were collected from investigation forms at the Ministry of health. All persons who acquired malaria in kenya during the years 1999-2001 were contacted by phone and questioned about use of chemoprophylaxis, attitudes towards malaria prevention, and disease course. Further information was extracted from hospital records. RESULTS: kenya accounted for 30 (18%) of 169 cases of malaria imported to israel and was the leading source of malaria in the study period. Of 30 malaria cases imported from kenya, 29 occurred after short (1-2 weeks) travel to holiday resorts in Mombassa. Average patient age was 43 /- 12 years, which is older than average for travelers to tropical countries. Only 10% of the patients were fully compliant with malaria chemoprophylaxis. The most common reason for non-compliance was the belief that a short trip to a holiday resort carries a negligible risk of malaria. Only 3 of 13 patients (23%) who consulted their primary physician about post-travel fever were correctly diagnosed with malaria. Twenty percent of cases were severe enough to warrant admission to an intensive care unit; one case was fatal. CONCLUSIONS: Measures aimed at preventing malaria and its severe sequelae among travelers should concentrate on increasing awareness of risks and compliance with malaria chemoprophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. Acute hepatitis and atovaquone/proguanil.A 31-year-old healthy man developed acute hepatitis after receiving atovaquone (250 mg) and proguanil (100 mg) for malaria prophylaxis daily for 25 days. Although atovaquone/proguanil is generally well-tolerated, this case highlights the hepatotoxic potential with considerable morbidity and should alert physicians to this harmful side effect.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. The need for high index of suspicion in early diagnosis of typhoid fever in young children.BACKGROUND: The diagnosis of typhoid fever in young children is more difficult than in the adult due to the unusual pattern of presentation. This letter aims to sensitize general physicians and paediatricians on the need for a high index of suspicion in the diagnosis of typhoid fever in children. METHOD: The case records of a child diagnosed with typhoid fever and a review of literature on the subject were used. RESULT: A five year old female misdiagnosed as a case of severe malaria and sepsis was found to have typhoid fever on post mortem examination. CONCLUSION: It is important to make an early diagnosis of typhoid fever in young children in order to prevent mortality from this treatable disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. Fatal hepatic necrosis due to pyrimethamine-sulfadoxine (Fansidar).pyrimethamine-sulfadoxine has been associated with severe and fatal cutaneous reactions as well as transient liver damage. We report the case of a patient who died of progressive hepatic failure caused by pyrimethamine-sulfadoxine administration. In addition, we summarize reports made to the food and Drug Administration since 1982 that focus on hepatotoxic reactions to pyrimethamine-sulfadoxine. We suggest that fatal hepatic injury can occur after treatment with pyrimethamine-sulfadoxine and that physicians who prescribe the drug should be aware of this possibility.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. Relapsing malaria infection acquired in kenya.An American physician-traveler to East africa presented with manifestations of cerebral malaria and was treated with intravenous quinidine for chloroquine-resistant falciparum malaria. He later relapsed with plasmodium ovale infection, despite previous primaquine therapy. Treatment of chloroquine-resistant malaria is discussed. The difficulty in diagnosing P. ovale infections and the predominance of this malaria species over P. vivax in East africa are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Fulminant plasmodium falciparum infection treated with exchange blood transfusion.A 48-year-old physician, who was not undergoing malaria chemoprophylaxis, contracted plasmodium falciparum while working in eastern thailand. In the hospital, he had a peak parasitemia of 72% RBCs infected, associated with CNS dysfunction. As an adjunct to chemotherapy, a double-volume whole-blood exchange transfusion was performed on the first hospital day, dropping the parasitemia to less than 1% within 32 hours. The patient's clinical condition improved, with a prompt reversal of CNS, hepatic, and renal complications. These results, combined with those in previously reported cases, suggest that exchange transfusion should be considered more generally as a life-saving procedure in P falciparum infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. Transfusion-acquired plasmodium malariae infection in two premature infants.Several diseases can be transmitted to infants via transfusion. The risk of acquiring an infection via transfusion is greatly increased in sick premature infants because they receive frequent transfusions. The full-term infant is not fully competent immunologically, and the premature infant is even less able to deal with infection. Ideally, the transfusion of infected blood, especially into immunoincompetent recipients, should not occur. However, because screening for malaria in nonendemic regions is not practical, physicians caring for sick premature babies should consider transfusion-acquired malaria as a possible cause of illness, especially when there is no response to antibacterial therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Fansidar resistant plasmodium falciparum infection in Surinam.The first cases of Fansidar resistant plasmodium falciparum infection in Surinam are reported after chloroquine-resistance was reported in 1972. The resistant cases were suspected by physicians and confirmed after performing the 35-day extended standard WHO 7-day in vivo-test. The distribution of drug resistant P. falciparum in Surinam is presented. The problem that drug resistance causes in the Malaria Eradication Program in Surinam is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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