Serum Ornithine Carbamoyl Transferase as a Surrogate Marker in Malaria

Ornithine carbamoyl transferase (OCT) activity and other liver function tests were studied in a total of 50 patients of clinical malaria and 15 controls. They were grouped as group I (positive for malarial parasite on peripheral blood smear, n=18), group II (negative for malarial parasite on peripheral blood smear (PBS) but responded to antimalarials, n=17) and group III (peripheral blood smear negative and did not respond to antimalarial therapy, n=15). The mean OCT levels were significantly raised in group I (6.79 ± 1.84 IU/L, p value = 0.006) and group II (5.0 ± 1.15 IU/L, p value = 0.014) as compared to controls (2.5 ± 1.13 IU/L) and returned to normal after treatment In contrast, group III had normal levels except in a case of kala azar and septicemia where OCT levels were high and increased further on treatment. Taking PBS positivity as a gold standard of diagnostic criteria, OCT had a sensitivity of 83% and specificity of 86% with a high positive predictive value of 88% as compared to ALT which had a lower sensitivity of 55% and specificity of 80%. The clinical response rate in PBS negative cases of fever having high OCT level was 83% as compared to 35% in cases with normal OCT level, making OCT a good surrogate marker of malaria. OCT levels could also be of prognostic significance as 2 cases of cerebral malaria had high OCT levels of 11.1 UAL and 10.7 IU/L, respectively.Key Words: Malaria, Ornithine carbamoyl transferase     

Algorithm of cardiopulmonary resuscitation in a cardiological hospital

Recent comments and amendments to routine algorithm of P. Safar's cardiopulmonary resuscitation, known as the ABCD principle, are critically analyzed. The primary mechanisms of thanatogenesis in sudden death in the majority of cases are not respiratory problems (requiring ABCD algorithm), but cardiac rhythm disorders. Based on their studies and practical and training experience, the authors suggest a new algorithm of cardiopulmonary resuscitation: UNIVERSAL, with the following steps: precordial stroke, indirect massage of the heart, forced ventilation of the lungs, venipuncture, electrocardiography, defibrillation by electric pulse therapy, electrocardiostimulation, and injections of adrenalin, atropine, and lidocaine. Introduction of this algorithm decreased hospital mortality of acute coronary patients, increased the rate of reanimation of suddenly dead patients, and reduced the incidence of iatrogenic complications of resuscitation.