Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 678 - 681

Association of the Electrolyte Disturbances (Na+, K+) with the Type and Severity of the Malarial Parasitic Infection

Jasmin H. Jasani, Sankalp M. Sancheti, Bijol S. Gheewala, Kaushik V. Bhuva, Varsha S. Doctor, Anand B. Vacchani, Vaidehi R. Patel, Lakhani Dhairya

1. Assistant Professor 2. 2nd year resident 3. 3rd year resident 4. 2nd year resident 5. 1st year resident 6. 2nd year resident 7. 2nd year resident 8. Final year MBBS student NAME OF DEPARTMENT (S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRI BUTED: Sumandeep Vidyapeeth, S.B.K.S. Medical College and Rsearch Center, Piparia, India.

Correspondence Address :
Jasmin H. Jasani
C-13, Sumandeep Vidyapeeth Campus, Piparia–Vadodara
Gujarat, India - 391760
Phone: 09978440069
E-mail: Drjasmin27@gmail.com

Abstract

Background and Objective: Malaria is a life-threatening disease which is caused by malaria parasite. It is a major public health problem in India. The purpose of this study was to examine the possible changes in the electrolytes (Na+ and K+) in cases of malaria, on the basis of their severity.

Aim: The aim of this study was to determine the severity of hyponatraemia and hypokalaemia and their association with the severity of malaria in a large cohort of known patients of malaria, which was caused by the P.falciparum and the P.vivax species of Plasmodium.

Material and Methods: The serum sodium and serum potassium levels were analyzed in two cohorts, each comprising 400 diagnosed cases of P. Falciparum and P. Vivax (200 +200) malaria respectively, in a tertiary care hospital in Vadodara, Gujarat, India. The patients were divided into two groups of severe (200) and non-severe (200) cases of malaria, based on the WHO guidelines and criteria.

Statistical Analysis: The data from the study were analyzed separately by using the Statistical Package for Social Sciences. The results were presented as Mean ± SD. A p value of <0.05 were considered to be significant.

Results: The mean levels of serum sodium and serum potassium in the cases of P. Falciparum malaria were significantly reduced as compared to those in the cases of P.vivax malaria. Hyponatraemia and hypokalaemia were more common in P.falciparum than in P.vivax malaria. The levels of sodium and potassium are significantly reduced in the severe malaria cases as compared to those in the non severe malaria cases.

Conclusion: Hyponatraemia and Hypokalaemia are common in malaria and they are associated with severe falciparum and vivax malaria. Correction of the electrolyte imbalance in the severe cases is of great significance in the management of the patients.

Keywords

Malaria, Sodium, Potassium, Severity

INTRODUCTION
Malaria is life threatening disease, with nearly half of the world’s population being vulnerable to this infection (1). Malaria accounts for an estimated 2-3 million deaths annually and it is also responsible for the untold morbidity in approximately 300 -500 million people annually (1). Four species of Plasmodium cause malaria in humans. These are P.falciparum, P.vivax, P.malariae and P.Ovale. P.falciparum is responsible for most of the deaths and most of the severe complications which result from malaria (2), which include cerebral malaria, anaemia and renal failure (3) Malaria, is endemic in many states of India and even in Gujarat. It is a mosquito borne disease which spreads by the bite of the anopheles mosquito and rarely by blood transfusion. The species which are mainly prevalent in India are P.falciparum and P. vivax (4). Electrolyte disturbances are known to be common in severe complicated malaria. Hyponatraemia has long been recognized as a complication of malaria. It had not been investigated previously how hyponatraemia was distributed among the various Plasmodium species, and its association with the severity of malaria is unknown.

The aim of this study was to determine the prevalence of hyponatraemia and other electrolyte imbalances and their association with the severity of malaria in a large cohort of patients with malaria which was caused by various Plasmodium species (5). The pathophysiology of the hyponatraemia in malaria remains unclear, but several studies have suggested that an increased secretion of vasopressin, either appropriately or inappropriately, plays an important role (6). Hyponatraemia is a decrease in the plasma sodium concentration to less than 135m.mol/l. The common causes are: integumentary loss (sweating, burns), gastrointestinal loss, renal loss, hepatic cirrhosis, etc.

The Grades of Hyponatraemia: Mild: 131 to 135 m.mol/l, moderate: 126 to 130 m.mol/l and severe: < 126 m.mol/l (7). Hyperkalemia is defined as an increase in the plasma potassium level to >5.0 m.mol/l. The common causes are: renal failure, hypo-aldosteronism, drugs like ACE inhibitors, etc. Hypokalaemia is defined as a decrease in the plasma potassium level to <2.5 m.mol/l. The common causes are burns, dehydration, etc. (8). The aim of the study was to establish an association between the electrolyte imbalance, the type of the Plasmodium species and the severity of malaria.

Material and Methods

This was a prospective study which was carried out over a period of 1 year in the S.B.K.S.M.I. and R.C Dhiraj General hospital, Piparia, Vadodara, Gujarat, India. The Dhiraj hospital is a 1226 bedded, multispecialty hospital which caters to the rural populations of Vadodara and Waghodia. All the admitted patients with clinically suspected malaria (as per the WHO criteria) and who were willing to participate, were enrolled in the study. Before their enrolment in the study, the nature and purpose of the study were explained to all the participants. The diagnosis of malaria was made after the examination of the peripheral smears (thick and thin) and on the basis of the malarial antigen detection rapid card test. There were 400 diagnosed cases of P. falciparum and P. vivax malaria (200 +200). The patients were divided into two groups of severe (200) and non severe (200) cases of malaria, based on the WHO guidelines and criteria. They are further divided on the basis of age into six groups.

Severe Malaria The patients were considered as having severe P. falciparum malaria, if they met the predefined, modified World Health Organization (WHO) criteria for severe malaria on admission or during hospitalization (“severity criteria”) : • A Glasgow Coma Scale (GCS) score of < 11 (which indicated cerebral malaria) or • Anaemia (haematocrit -< 0.20 L/L with a parasite count of > 100.000/μL) or • Jaundice (serum bilirubin -> 50 μmol/L with a parasite count of > 100.000/μL) • Renal impairment (urine output- < 400 mL/24 h and serum creatinine- > 25 μmol/L) or • Hypoglycaemia (blood glucose -< 2.2 mmol/L) or • Hyperparasitaemia (> 10% parasitaemia) or • Shock (systolic blood pressure- < 80 mm Hg with cold extremities) • Fulfilment of any one of the above criteria was considered as suggestive of severe malaria.

Inclusion Criteria 1. All the confirmed patients of malaria above 1year of age. 2. Willingness in giving an informed consent. Exclusion Criteria 1. Unwillingness in giving an informed consent. 2. Already enrolled in the study. For all the patients who were willing to participate in the study, their demographic profile, their complete history with vitals and relevant system examination with relevant laboratory investigations was recorded in a preformed proforma and they were subjected to the following investigations: — Complete Blood Count (CBC) : [Hb, TC, DC and platelet] — Peripheral Smear examination for the malaria parasite — Serum billirubin — Serum Creatinine — Serum electrolyte (Na+, K+) The methodology of the procedures to be followed: 1. CBC by using (“Sysmex KX-21 Three Part Differential Automated Haematology Analyser”). 2. PSMP by the thick and thin smear methods; staining with the Giemsa stain. 3. Evaluation of serum billirubin and creatinin by using a semiautomated biochemistry analyser. 4. Evaluation of serum electrolyte (Na+, K+) by using a Prolyte fully automated electrolyte analyser. Statistical Analysis: The data from the study was analyzed separately by using the Statistical Package for Social Sciences. The results were presented as Mean ± SD (Standard deviation) and a p value of <0.05 was considered as significant.

Results

The above Table shows that males were more commonly affected than females. P.falciparum was more prevalent in the 13 to 30 years age group and P.vivax was more prevalent in the 31-50 years age group.

The above Table shows that hyponataemia and hypokalaemia were more common in P.falciparum than in P.vivax malaria.

The tables and the charts which are shown above revealed that hyponataemia and hypokalaemia were more common in the severe cases of malaria than in the non severe cases of malaria.

Discussion

Malaria is a major cause of mortality and morbidity in the tropical regions in the world. An estimated 300-500 million persons suffer from malaria every year and more than 1 million die each year (9). P.Falciparum is the species which is most commonly associated with the severe and complicated forms of this disease (10). The results of this study showed that the malaria infection led to a reduction in the levels of both sodium and potassium. Hyponatraemia and hypokalaemia were more common and moresevere in the severe cases of malaria than in the non severe cases of malaria. Hyponatraemia and hypokalaemia were also more common in the P.faciparum then P.vivax cases in both the severe and the non severe forms of malaria. Fryatt RJ, et al suggested that the mild hyponatraemia that could be seen in the acute stages of malaria did not affect the mortality and the morbidity (11). Some observations also suggested that in the non severe cases, there was a very mild reduction in the sodium and potassium levels.

Dworak et al (1975) (12) stated that there was a progressive decrease in the Na+ and K+ levels within 12 hrs of the parasite’s occupancy, whereas Kakkilaya (2002) (13) reported mild hyponetraemia in the malaria patients. Ebele J Ikekpeazu et al (2010) (14) reported that there was a reduction in the Na+ and K+ level in the cases of malaria. Heindricks et al reported that the reduction in the K+ levels was because the host cells lost up to 75 to 80 % of their normal potassium content during the course of the malaria attack (15). The observation that hyponatraemia which was seen in malaria was caused by any Plasmodium species, suggested that the hyponatraemia per se was unlikely to represent an exclusive feature of falciparum malaria, but that it merely reflected the effects of the severity of the disease.

A limitation of our study was that we did not compare the electrolyte levels between the hospitalized patients and the outpatients. But it seems unnecessary to assess the electrolyte levels in the outpatients with malaria due to the limitation of the costs and the measurement availability in the developing countries. Besides the clinical suspicion, the response to the anti-malarial treatment suffices in most of the outpatients. The importance of assessing hyponatraemia that complicates severe malaria is in the fact that hyponatraemia is associated with adverse outcomes and that it should be specifically and aggressively treated.

Conclusion

Hyponatraemia and hypokalaemia are common in malaria and they are associated with the severe forms of falciparum and vivax malaria than with non severe malaria. Hyponatraemia and hypokalaemia are more common in P.falciparum than in P.vivax malaria. This study drew attention to the need to manage the electrolyte derangements for the overall management of the malaria infections. From the clinical point of view, hyponatraemia is an indicator of the disease severity. In general, serum electrolytes should be estimated in the malaria patients of all the age groups to prevent the complications which might result from electrolyte depletion, as these may produce grave consequences. The precise patho physiological mechanisms of the hyponatraemia in malaria need to be further studied.

References

1.
Mishra SK, Mohapatra S, Mohanty S, Patel NC, Mohapatra DN. Acute renal failure in falciparum malaria. Journal, Indian Academy of Clinical Medicine 2002; 3 : 141-47.
2.
Nchinda TC. Malaria: A re-emerging disease in Africa. Emerging Infectious Diseases 1998; 4 (3) : 1-8.
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Kocha DK, Agarval P, Kochar SK, Jain R, Rawat N, Srivasta T. Hepatocyte dysfunction and hepatic encephalopathy in plasmodium falciparum malaria. Q Journal of Medicine 2003; 96 : 505-12.
4.
Park K. Preventive and Social Medicine: Ed. 21: Malaria: Pg. No. 231
5.
Miller LH, Makaranon P, Sitprija V, Suebsanguan C, Canfield CJ. Hyponatraemia in malaria. Ann Trop Med Parasitol 1967; 61:265-79.
6.
Sowunmi A, Newton CR, Waruiru C, Lightman S, Dunger DB. Arginine and vasopressin secretion in Kenyan children with severe malaria. J Trop. Pediatr 2000; 46:195-199.
7.
Harrison. Hyponatraemia: Harrison’s Principles of Internal Medicine 16th edition :Pg. No. 255.
8.
Harrison. Hyperpotassaemia: Harrison’s Principles of Internal Medicine 16th edition :Pg. No.261.
9.
Regional guidelines on the management of severe falciparum malaria in the level II hospitals. World Health Organisation, south east Asia regional office, New Delhi, 2004.
10.
Tayler TE, Stricklanad GT. Malaria. In:Strickland GT. Hunter’s tropical medicine and emerging infectious diseases. 8th edition Philadelphia: W.B. Saunders Company, 2000; 614-43.
11.
Fryatt RJ, Teng JD, Harries AD, Moody AH, Hall AP, Forsling ML. The plasma and urine electrolyte concentrations and the vasopressin levels in patients who were admitted to the hospital for falciparum malaria. J Trop Georg Med 1989; 41(1):57-60.
12.
Dworak JA, Miller LH, Whitehouse WC, Shirosh T,. Invasion of the electrolytes by the malaria parasite. Science, 1975; 187 : 748-50.
13.
Kakkilaya BS,. Malaria: in Park’s Textbook of Preventive and Social Medicine; 15th Ed. K Park, Bhanar Sides Bhanot Publishers. 1997; 188-202.
14.
Heindricks RG, Hassan AH, Oulrinde LO, Akindkani A.. Malaria in early childhood. Annals of Tropical Medicine, 1971; 65: 316-20.
15.
Ikekpeazu EJ, et al. A study on malaria parasitemia :-effect on the sodium and potassium levels. A Journal of Biology and Medicine, 2010; 2 (2):20-25.

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