Malaria Vaccine:The Pros and Cons

Background: Malaria is an important parasitic disease of humans caused by infection with a parasite of the genus Plasmodium and transmitted by female anopheles. Infection caused by P. falciparum is the most serious of all the other species (P. ovale; P. vivax and P. malariae) especially in terms of morbidity and mortality hence the reason why most of the research has been focussed on this species. The disease affects up to about 40 per cent of the world's population with around 300-500 million people currently infected and mainly in the tropics. It has a high morbidity and mortality especially in resource-poor tropical and subtropical regions with an economic fall of about US$ 12 billion annually in Africa alone. relevant literatures were reviewed from medical journals; library search and internet source. Other relevant websites like PATH; Malaria Vaccine Initiative and Global Fund were also visited to source for information. The key words employed were: malaria; vaccine; anopheles mosquito; insecticide treated bed-nets; pyrethroids and Plasmodium. several studies have underscored the need to develop an effective human malaria vaccine for the control and possible eradication of malaria across the globe with the view to reduce the morbidity and mortality associated with the disease; improve on the social and economic losses and also protect those at risk. It is very obvious that the need for effective human malaria vaccine is not only to serve those living in malaria endemic regions but also the non-immune travellers especially those travelling to malaria endemic areas; this would offer cost effective means of preventing the disease; reducing the morbidity and mortality associated with it in addition to closing the gap left by other control measures. It is very obvious that there is no single control measure known to be effective in the control of malaria; hence the need for combination of more than one method with the aim of achieving synergy in the total control and possible eradication of the disease. It suffices to say that despite the use of combination of more than one method (e.g. drugs treating patients; breaking the life cycle of the vector mosquito using larvicides; clearing swamps and other mosquito breeding sites); no much progress was made towards achieving this goal; hence the renewed interest especially with regards to vaccine development

Role of Iloprost and Bosentan in Pulmonary Arterial Hypertension

Background: Pulmonary hypertension is a disorder that is perpetually fatal unless a tentative therapy is instituted. It can be described as a syndrome considering its clinical and pathophysiological manifestations. In this disorder; there is an imbalance within the vascular mediators which possibly arises due to pulmonary endothelial cell injury or dysfunction. Pharmacotherapy in PAH is aimed to reverse the imbalance present among the chemical mediators; offer relief to patients from symptoms and prolong their survival. In addition to other supportive measures; iloprost and bosentan form the cornerstone of treatment. Iloprost; a vasodilator and stable analogue of prostacyclin; confers great benefit through vasodilation; antiproliferative effects and inhibition of platelet aggregation. Bosentan; an oral non-specific endothelin-receptor antagonist with dual activity on both ETA and ETB receptors; has been shown to improve the patient's quality of life on the overall. Method: Review of relevant literature was conducted using manual library search and internet articles. The key words employed were pulmonary hypertension; prostacyclin; endothelin-receptor antagonist; hereditary haemorrhagic telangiectasia; iloprost and bosentan. The National Heart; Lung and Blood Institute website was also used in the course of this review. Results: Several studies were able to outline the haemodynamic advantages of iloprost and bosentan in pulmonary arterial hypertension; as evident by improvement in six-minute walk test of patients treated with these agents. Conclusion: This review was able to outline the pharmacotherapeutic benefits and role played by inhaled iloprost (in addition to its stable nature and minimal adverse effects) and bosentan in the manage- ment of PAH. Several studies have shown that these agents improve the patient's quality of life on the overall considering their favourable effect on pulmonary haemodynamics; symptoms reduction and exercise tolerance

Acute pulmonary embolism: A review

Background: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE; there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. Method: Literature was reviewed using available medical journals; Science direct; Medline and Embase databases. Key words employed were: pulmonary embolism; deep venous thrombosis (DVT); venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart; Lung and Blood Institute websites. Results: Studies have shown that hypercoagulability state; stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk for bleeding. Conclusion: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol

Acute Pulmonary Embolism: A Review

Background: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE; there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. Method: Literature was reviewed using available medical journals; Science direct; Medline and Embase databases. Key words employed were: pulmonary embolism; deep venous thrombosis (DVT); venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart; Lung and Blood Institute websites. Results: Studies have shown that hypercoagulability state; stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk for bleeding. Conclusion: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol

Acute Pulmonary Embolism: A Review

Background: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE; there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. Method: Literature was reviewed using available medical journals; Science direct; Medline and Embase databases. Key words employed were: pulmonary embolism; deep venous thrombosis (DVT); venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart; Lung and Blood Institute websites. Results: Studies have shown that hypercoagulability state; stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk for bleeding. Conclusion: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol

Pharmacotherapy for Chronic Heart Failure

Background : Heart failure is a chronic and progressive disorder which results due to inability of the heart to pump adequate blood to meet up the metabolic demands of the body. Detecting patients with heart failure could be simple but rather complex of clinical decisions as presentation could be classical or non-specific with minimal symptoms and or signs. Management is aimed at relieving symptoms; improving quality of life; preventing hospitalisation and arresting disease progression thus prolonging survival. In addition to pharmacologic measures; non-pharmacologic ones are also employed. Method : Relevant literature was reviewed using medical journals and also via internet. The key words employed were: Heart failure; Chronic heart failure; Diuretics; Vasodilators; Angiotensin receptor blockers (ARBS) and Angiotensin converting enzyme inhibitors (ACEI). The National Heart; Lung and Blood Institute; Canadian Cardiovascular Society; American College of Cardiology websites were also used in the course of this review. Results: This review was able to support the use of beta- blockers; ACEI; ARBS; digitalis; diuretics; vasodilators and aldosterone antagonists in the management of chronic heart failure. Conclusion : The objectives of drug therapy in heart failure includes the short-term goals of stabilising the patient; improving haemodynamic function and conferring symptomatic improvement; as well as the long-term goal of limiting disease progression; decreasing hospital re-admission rates and improving survival. The cause needs to be established and aggravating factors identified (and where possible treated). Most of the drugs; if not all; are used in combination with one another to achieve maximal therapeutic goal. Use of some drugs could be entertained as an add-on therapy depending on any co-existing medical condition.1