presented by mc. pochong uthaitas mc. wuttipat pusanasuwannasri 3 rd years medical cadet...
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Presented byMC. Pochong UthaitasMC. Wuttipat Pusanasuwannasri3rd years medical cadet Phramongkutklao college of medicine 11
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BackgroundBackground
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Increasing in mortality rate of severe vivax malaria
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ObjectivesObjectives
• To describe the geographical variation in prevalence of severe vivax malaria
• To describe the different presenting syndromes and characteristics
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MethodsMethods
Systematic reviews and meta analysis
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MethodsMethods
Search term and search strategySearch term and search strategy
Patients: (1) Plasmodium vivax, (2) Severe OR complicated, (3) 1 AND 2.Outcomes: (4) Cerebral complication, (5) Convulsions, (6) Kidney injury, (7) Renal failure, (8) Hemoglobinuria, (9) Circulatory collapse, (10) Shock, (11) Jaundice, (12) Hyperbilirubinemia, (13) Hepatic dysfunction, (14) Bleeding, (15) Hemorrhage, (16) Thrombocytopenia, (17) Disseminated intravascular coagulation, (18) DIC, (19) Acute respiratory distress syndrome, (20) ARDS, (21) Pulmonary edema, (22) Metabolic acidosis, (23) Hyperlactatemia, (24) Severe anemia, (25) Hypoglycemia, (26) Death
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MethodsMethods
Selection criteriaSelection criteria
Inclusion criteria
•Thrombocytopenia and severe falciparum criteria
Exclusion criteria •Duplicate reporting
• Mixed infections
• Insufficient data
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MethodsMethods
Bias assessment and quality assureranceBias assessment and quality assurerance
• Eligibility for inclusion of every article was reviewed by independent reviewers
• Disagreements between reviews were validated by an independent person
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Statistical analysisStatistical analysis
Software STATA version 12 was used for statistical analysisSoftware STATA version 12 was used for statistical analysis
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ResultsResults
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ResultsResults
77 studies with severe vivax77 studies with severe vivax
Geographical origin : from 77 studies42 (54.5%) South-east Asia17 (22.1%) Americas10 (13.0%) Eastern-Mediterranean8 (10.4%) Western pacific
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Results for 1st objectiveResults for 1st objective
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Results for 2nd objectiveResults for 2nd objective
• To describe the geographical variation in prevalence of severe vivax malaria
• To describe the different presenting syndromes and characteristics
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ResultsResults
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Severe Thrombocytopenia 52528 888 4.7 2.3-7.0
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ResultsResults
Severe Thrombocytopenia 45775 888 8.6 5.4-11.8
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ResultsResults
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Severe vivax malaria- increase large number in non-endermic area;
India
- In patient with vivax malaria mortality rate was 28.2%
Most prevalent severity sign reported was thrombocytopenia(26.1%)
DiscussionDiscussion
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One contributor to this discrepancy is the inclusion of thrombocytopenia as a severity criterion in recent series One contributor to this discrepancy is the inclusion of thrombocytopenia as a severity criterion in recent series
Prevalence of severe vivax in IndiaPrevalence of severe vivax in India
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Unclear description of Chloroquine resistance except in the island of new Guinea, Indonesia Papua and Amazonas
DiscussionDiscussion
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DiscussionDiscussionMisdiagnosis caused by other febrile illness and co-infection
Non endemic areaEndemic area202
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Change in strain virulence
DiscussionDiscussion
Increase in reported cases
No hard data available to support this hypothesis
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ConclusionConclusion
Increase in reported case of severe vivax in certain geographical regionIncrease in reported case of severe vivax in certain geographical region
Cannot be explained with the current knowledgeCannot be explained with the current knowledge
The use of thrombocytopenia as an independent severity criterion required justification
The use of thrombocytopenia as an independent severity criterion required justification
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TitleSystematic review and meta-analysis
AbstractProvide structured summary
Introduction Clear objectives
Critical appraisalCritical appraisal
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MethodsSearch strategySearch termEligibility criteria Information sourceBias assessment
Critical appraisalCritical appraisal
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ResultsPrecise Reasonable
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