We are using the word “urolithiasis” for a kidney stone, which has entered the ureter. The family physicians usually use the term “renal colic”, but in fact it is “ureteric colic”.
If the attack subsides with a single intravenous analgesic injection e.g. analgesic diclofenac, then the doctor needs to see the size of the stone and its location in the ureter.
If the pain does not subside, even after 24 hours, and the patient is still in agony, then a ureteric stent is the solution, especially if the patient can afford the expensive treatment. By putting the stent, not only is the pain relieved, but it also facilitates the stone to pass out.
I am writing this article in reference especially to the patients, whose colic has subsided with one or two injections, and the X-ray KUB/sonography/CT KUB imaging studies show a stone, less than one cm, located somewhere in the "ureter". Advising the patient to drink a glass of water, one hourly, is the best advice (some doctors use diuretics).
The good news is that now there are two drugs which are already available which can be prescribed to such patients, to help in the expulsion of the stone specially if it is in the distal one third of the ureter. These are - Amlodepine and Alpha Blockers. The former is already being used for hypertension and the latter for enlarged prostate.
NEUROLOGICAL PRESENTATION OF MALARIA IN YEMEN HAS POOR PROGNOSIS
Malaria is a serious burden on health services in Yemen; it accounts for 17% of paediatric hospital admissions, and more than half of cases are classified as severe falciparum malaria. A two site observational study by Al-Taiar and colleagues found that female sex, history of fits, Blantyre coma score < 2, and hyperlactataemia were associated with poor prognosis. Of the 26 children who died, 22 presented with neurological signs; this is in contrast to Africa, where severe anaemia and respiratory distress are better predictors of fatal outcome.
BMJ, 2006; 333 : 827.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.