Mixed Infection of Vivax and Falciparum Malaria with Severe Manifestations of Malaria at the General Hospital of the Christian University of Indonesia: A Case Report

Malaria is still a health problem in Indonesia. The number of malaria cases according to the 2018 RISKESDAS reached 8076 cases, and the highest number was obtained from Papua province with 3,334 cases. Multiple infection malaria in Indonesia according to RISKESDAS 2018, has a rate of 0.01% of the total cases, namely Plasmodium Falciparum malaria and Plasmodium non Falciparum malaria. A 47 year old man was referred from the clinic with complaints of high fever preceded by chills 10 days before being admitted to the hospital. Accompanied by shortness of breath, unable to get off the treatment bed due to feeling very weak, nauseous, sick and having a bulging stomach. Physical examination revealed a pale conjunctiva, ronkhi in the lower field of the right lung, dim percussion in the basal of the left lung, hepatomegaly, splenomegaly, shifting dullness. Ring form vivax, on chest X-ray found a left pleural effusion. It is known that the patient previously lived in Papua from September 2018 to May 2019. During treatment, the patient was given artesunate injection therapy, dihydroartemisin + piperaquine and primaquin for seven days of treatment. At the end of the treatment, another chest X-ray was performed and re-examination of the peripheral blood smear, no more pleural effusions were found and no parasites were found on re-examination of the peripheral blood smear. Mixed infection of vivax and falciparum malaria, is a rare case that may occur in endemic areas where both plasmodium can be found. The prevalence in Indonesia according to RISKESDAS is only about 0.01% of all malaria cases in Indonesia.

The Prevalence of Postoperative Pain Following Day Surgery in the First 48 Hours at Aga Khan University Hospital, Nairobi

Introduction: Day case surgery services are increasing all over the world. The prevalence of postoperative pain after day surgery is found to be high ranging from 17% to 60%. Little is known about the prevalence of postoperative pain, in Kenya and East Africa, after day case surgeries. Objective: The objectives of this study were to investigate the prevalence of postoperative pain after day surgery at Aga Khan University (AKUH), Nairobi, to determine the severity/intensity of postoperative pain following day case surgery, and to determine the influence of anxiety and worry on the patients report on postoperative pain. Study site: The Aga Khan University Hospital, Nairobi. Study design: Prospective, non-interventional study. Study population: All patients aged between 18 and 68 years scheduled for day surgery at Aga Khan University Hospital, Nairobi. Sample size: One hundred and fifty patients. Duration of the study: This is a prospective study that was carried out between March and June 2009. Methodology: Consecutive sampling was carried out until sample size was achieved. The purpose and nature of the study was explained to patients before informed consent was obtained. They were explained how to score their pain by using a visual analogue scale prior to the surgical procedure. A questionnaire was used to collect data from the patients. Follow up information was obtained through interviews over the telephone at 24 and 48 hours, after discharge from the DSU. Results: The prevalence of postoperative pain after day care surgery was found to be 58% within 30mins postoperatively, 55.3% after 24 hours, and 34.7% after 48 hours following surgery. The prevalence of moderate to severe postoperative pain was 9.6%. This study has shown that the association between postoperative pain and anxiety was significant at 24 hour and 48 hour follow up. However such association with worry was significant only at 48 hour follow up. Conclusion: The overall prevalence of postoperative pain after day surgery at the Aga Khan University Hospital, Nairobi was noted to be different from what has been reported in the literature. The prevalence of moderate and severe pain however, is less than reported in the literature.